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Kompendium 2020 Forschung & Klinik

Das Kompendium 2020 der Universitätsklinik für Orthopädie und Unfallchirurgie von MedUni Wien und AKH Wien (o. Univ.-Prof. R. Windhager) stellt einen umfassenden Überblick über die medizinsichen Leistungen und auch die umfangreichen Forschungsfelder dar. Die Veröffentlichungen zeigen die klinische Relevanz und innovative Ansätze der einzelnen Forschungsrichtungen. Herausgeber: Universitätsklinik für Orthopädie und Unfallchirurgie MedUni Wien und AKH Wien Prof. Dr. R. Windhager ISBN 978-3-200-07715-7

Das Kompendium 2020 der Universitätsklinik für Orthopädie und Unfallchirurgie von MedUni Wien und AKH Wien (o. Univ.-Prof. R. Windhager) stellt einen umfassenden Überblick über die medizinsichen Leistungen und auch die umfangreichen Forschungsfelder dar. Die Veröffentlichungen zeigen die klinische Relevanz und innovative Ansätze der einzelnen Forschungsrichtungen.

Herausgeber: Universitätsklinik für Orthopädie und Unfallchirurgie
MedUni Wien und AKH Wien
Prof. Dr. R. Windhager

ISBN 978-3-200-07715-7

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<strong>Kompendium</strong> <strong>2020</strong><br />

<strong>Forschung</strong> & <strong>Klinik</strong><br />

Universitätsklinik für<br />

Orthopädie und Unfallchirurgie<br />

MedUni Wien und AKH Wien<br />

ISBN 978-3-200-07715-7<br />

www.meduniwien.ac.at/ortho-unfall


.O.R.E.<br />

I N S T I T U T E


Inhalt/Impressum<br />

3<br />

Die <strong>Klinik</strong><br />

4 Editorial<br />

6 Klinische Leistungen und Operationen<br />

9 Hohe Ambulanzfrequenz durch Spezialangebote<br />

10 Interview mit o. Univ.-Prof. Dr. Reinhard Windhager:<br />

„Seltene Erkrankungen und komplizierteste Behandlungen<br />

sind unser Standard“<br />

14 Die Expertinnen und Experten auf einen Blick<br />

20 Ambulanzverzeichnis der Universitätsklinik<br />

für Orthopädie und Unfallchirurgie<br />

Impressum:<br />

Herausgeber:<br />

Universitätsklinik für<br />

Orthopädie und<br />

Unfallchirurgie MedUni Wien<br />

und AKH Wien<br />

o. Univ.-Prof. Dr. Reinhard<br />

Windhager<br />

Währinger Gürtel 18–20<br />

1090 Wien<br />

Redaktion & Gestaltung:<br />

Unlimited Media<br />

www.unlimitedmedia.at<br />

Lektorat: Sophie Hermann,<br />

BSc, Alexandra Lechner<br />

Fotos: iStock-120190423,<br />

Unlimited Media, MedUni<br />

Wien/Christian Houdek,<br />

Mark Glassner<br />

Druckerei: Copydruck KG<br />

Sandleitengasse 9–13<br />

1160 Wien<br />

Wien, Juli 2021<br />

ISBN 978-3-200-07715-7<br />

TOP-Studien<br />

22 Quantitative Biochemical MRI of Hyaline Cartilage<br />

26 Analysis of Running-Related Injuries: The Vienna Study<br />

30 Rheumatoid Arthritis Disease Activity and the Risk<br />

of Aseptic Arthroplasty Loosening<br />

34 OSTEOGROW: Acceleration of Bone Healing<br />

37 A Prediction Model for Total Knee Arthroplasty<br />

40 tPA Serum Antigen Levels Predict ARDS<br />

in Polytraumatized Patients<br />

43 3D Biochips for Research on Inflammatory<br />

Musculoskeletal Diseases<br />

46 Biological Regeneration in Early Osteoarthritis<br />

49 Total Hip Arthroplasties after Chiari Pelvic Osteotomy<br />

52 The MOCART 2.0 Knee Score: Morphological MRI<br />

for the Assessment of Cartilage Repair<br />

55 The Genetic Landscape of Axonal Neuropathies:<br />

Focus on MME<br />

58 Distal Femur Replacement – Differences between<br />

Oncologic and Non-Oncologic Conditions<br />

62 Biomechanical Evaluation of Intramedullary<br />

Jones Fracture Fixation<br />

65 Development of a New Electronic Navigation System<br />

Publikationen<br />

68 Originalarbeiten <strong>2020</strong><br />

E-Book<br />

www.meduniwien.ac.at/orthopaedie<br />

www.unlimitedmedia.at/orthopaedie<strong>2020</strong>


Editorial<br />

4<br />

Liebe Leserinnen und Leser!<br />

Es freut mich, Ihnen zum vierten Mal das <strong>Kompendium</strong> der gemeinsamen<br />

<strong>Klinik</strong> für Orthopädie und Unfallchirurgie, drei Jahre nach der Gründung dieser<br />

<strong>Klinik</strong> und nach einem bemerkenswerten Jahr, präsentieren zu können.<br />

o. Univ.-Prof. Dr. Reinhard Windhager<br />

Viel wurde in den letzten Monaten über die Auswirkungen der Pandemie<br />

reflektiert und publiziert, und es braucht nicht weiter ausgeführt zu werden,<br />

wie sehr sich diese weltweite Katastrophe auf unsere Leistungszahlen im<br />

klinischen Alltag niedergeschlagen hat. Trotz all dieser Belastungen ist es<br />

gelungen, spitzenmedizinische Leistungen weiter und in unveränderter<br />

Frequenz durchzuführen. Es sei allen Entscheidungsträgern gedankt, dass<br />

dies in einem tertiären Versorgungszentrum möglich gemacht wurde. Auch<br />

andere Aspekte dieser durch die Pandemie belasteten Zeit sollten nicht<br />

unerwähnt bleiben, wie die Intensivierung der Digitalisierung, die sich positiv<br />

im klinischen Alltag, aber vor allem im Bereich der wissenschaftlichen<br />

Kommunikation ausgewirkt hat.<br />

War es anfangs schwer vorstellbar, dass Workshops, Seminare, Symposien<br />

und auch größere Kongresse digital abgehalten werden, so ist dies mittlerweile<br />

zum Alltag geworden und wird in gewissem Ausmaß auch in Zukunft<br />

nicht mehr wegzudenken sein. Diese gewonnene Zeit hat sich auch in der<br />

regen Publikationstätigkeit niedergeschlagen und dazu beigetragen, dass<br />

zahlreiche neue Projekte initiiert werden konnten. Die folgenden Seiten<br />

sollen Ihnen einen kurzen Einblick in die Spitzenleistungen der <strong>Forschung</strong>saktivitäten<br />

unserer <strong>Klinik</strong>, die wie viele andere in Top-Journalen publiziert<br />

werden konnten, geben.<br />

An dieser Stelle sei auch allen Mitarbeiterinnen und Mitarbeitern für ihren<br />

unermüdlichen Einsatz in diesen schwierigen Zeiten gedankt und dafür, dass<br />

diese belastende Zeit positiv genutzt werden konnte.<br />

Ich wünsche Ihnen viel Vergnügen beim Studium dieser Lektüre und würde<br />

mich freuen, durch den einen oder anderen für Sie bemerkenswerten Aspekt,<br />

Interesse an einer zukünftigen Kooperation zu wecken.<br />

Ihr Reinhard Windhager


Zahlen und Fakten<br />

6<br />

Klinische Leistungen<br />

und Operationen<br />

Die Universitätsklinik für Orthopädie und Unfallchirurgie ist<br />

eine Großklinik mit einem umfassenden Leistungsspektrum.<br />

Trotz der umfangreichen Einschränkungen durch die Corona-Pandemie<br />

wurden im Jahr <strong>2020</strong> an der Universitätsklinik für Orthopädie und Unfallchirurgie<br />

insgesamt 6.530 Operationen durchgeführt. Im Jahr davor waren<br />

es 7.039 – allerdings ohne Corona-Einschränkungen.<br />

2.449 Operationen fielen in den Bereich der Orthopädie. Wobei hier betont<br />

werden muss, dass es sich zumeist um hochspezifische Eingriffe handelte, die<br />

an anderen Spitälern in Österreich gar nicht durchgeführt werden können. Es<br />

wurden 315 Hüftendoprothesen, 277 Knieendoprothesen und 149 Fusionen der<br />

Wirbelsäule durchgeführt. Hinzu kamen 341 Arthroskopien, 78 Fußoperationen,<br />

286 Tumorresektionen und 83 Osteosynthesen. An der Klinischen Abteilung für<br />

Unfallchirurgie wurden 3.265 Operationen durchgeführt.<br />

Klinische Leistung Orthopädie 2019 <strong>2020</strong><br />

Operationen gesamt 2.945 2.449<br />

unter anderem:<br />

Fusionen der Wirbelsäule 173 149<br />

Endoprothetische Versorgungen (gesamt) 731 653<br />

davon Hüftendoprothesen 349 315<br />

davon Knieendoprothesen 343 277<br />

Arthroskopien (alle Gelenke) 435 341<br />

Fußoperationen 132 78<br />

Tumorresektionen 372 286<br />

Osteosynthesen 94 83<br />

Klinische Leistung Unfallchirurgie<br />

Stationäre Aufnahmen 6.729 6.054<br />

Anzahl Operationen 4.094 3.265<br />

unter anderem:<br />

Endoprothetische Versorgungen (gesamt) 249 192<br />

Schädel-Hirn-Trauma 39 57<br />

Wirbelsäulen-OP 72 70<br />

Becken-/Acetabulum-Frakturen 13 32<br />

Knie-Binnenverletzungen 474 334<br />

Rekonstruktive Operationen an der Schulter 78 83<br />

Handverletzungen 409 329<br />

Thorax-/Abdomenverletzungen 34 24<br />

periprothetische Frakturen 43 46<br />

Osteosynthesen 763 606


Die bewährte<br />

Hüfte<br />

Qualität,<br />

die bewegt.<br />

www.implan-tec.at


Zahlen und Fakten<br />

9<br />

Hohe Ambulanzfrequenz<br />

durch Spezialangebote<br />

Die Universitätsklinik für Orthopädie und Unfallchirurgie versteht<br />

sich als universitäres Zentrum zur Diagnose, Therapie<br />

und Prävention von angeborenen und erworbenen Erkrankungen<br />

des Bewegungsapparates. Durch den hohen Grad an Spezialisierung<br />

und das große Angebot an Spezialambulanzen sind<br />

die Ambulanzen einer sehr starken Frequenz ausgesetzt. Die<br />

im Vergleich zu 2019 niedrigen Zahlen sind der Corona-Pandemie<br />

geschuldet – wobei bei den Versorgungen im Gipszimmer<br />

sogar eine massive Steigerung im Vergleich zu den Vorjahren<br />

bemerkbar war.<br />

In der Klinischen Abteilung für Orthopädie werden 21 höchst spezialisierte<br />

Ambulanzen auf internationalem Niveau angeboten. Insgesamt kam es im<br />

Jahr <strong>2020</strong> zu 23.306 Ambulanzbesuchen. Die höchsten Frequenzen wiesen<br />

folgende Ambulanzen auf: Schmerztherapie (2.343), Tumororthopädie<br />

(2.872), Rheumaorthopädie (2.486), Kinderorthopädie (1.805), Wirbelsäule<br />

(1.550), Sportorthopädie (1.512), Endoprothetik (1.133), Sarkome (852) und<br />

die Fußambulanz (403).<br />

2019 <strong>2020</strong><br />

Ambulante Frequenzen Orthopädie (gesamt) 31.800 23.306<br />

Schmerztherapie 5.097 2.343<br />

Tumororthopädie 3.738 2.872<br />

Rheumaorthopädie 3.019 2.468<br />

Kinderorthopädie 2.145 1.805<br />

Wirbelsäule 1.718 1.550<br />

Sportorthopädie 1.712 1.512<br />

Endoprothetik 1.320 1.133<br />

Knochen- und Weichteilsarkome 951 852<br />

Fußambulanz 694 403<br />

Ambulante Frequenzen Unfallchirurgie<br />

Ambulante Frequenzen (ABF) Erstversorgung 71.216 49.342<br />

Ambulante Kontrollen (ABK) Nachbehandlung 51.452 34.704<br />

SchockraumpatientInnen 566 507<br />

Eingriffe in der Wundversorgung 4.675 3.616<br />

Versorgungen im Gipszimmer 15.273 19.579


<strong>Klinik</strong><br />

10<br />

Seltene Erkrankungen und<br />

komplizierteste Behandlungen<br />

sind unser Standard<br />

Die Universitätsklinik für Orthopädie und Unfallchirurgie ist eine<br />

der größten im AKH Wien und der MedUni Wien und genießt<br />

vor allem im Bereich der hochspezialisierten Operationen<br />

internationalen Ruhm. Die Corona-Pandemie hat aber, bei der<br />

Behandlung der Patientinnen und Patienten, den über die letzten<br />

Jahre steigenden Operationsfallzahlen und auch im Bereich der<br />

<strong>Forschung</strong> massive Probleme bereitet und Rückgänge bewirkt.<br />

o. Univ.-Prof. Dr. Reinhard Windhager<br />

Welche Herausforderungen bewirkte die Corona-Krise im Jahr <strong>2020</strong> in<br />

Bezug auf die Behandlung der Patientinnen und Patienten?<br />

Das im Rahmen der Corona-Krise notwendige Schließen und konsekutive<br />

Öffnen von Spitalsressourcen ging mit einem enormen organisatorischen<br />

Aufwand einher, insofern als die Patientinnen und Patienten nicht auf einen<br />

bestimmten Termin verschoben werden konnten, sondern in permanenter<br />

Warteposition verharren mussten. Die sich ständig ändernde Verfügbarkeit<br />

von Ressourcen war mit einer massiven organisatorischen Belastung des<br />

gesamten ärztlichen und pflegerischen Personals verbunden.<br />

Welche Teile der Patientenversorgung kamen zu kurz? Was wurde an<br />

wichtigen Operationen verschoben, was wieder aufgeholt?<br />

Grundsätzlich kann festgehalten werden, dass medizinische Versäumnisse<br />

in keiner Weise zu verzeichnen waren, insofern als eine klare Priorisierung<br />

von medizinisch dringlich notwendigen Eingriffen erfolgte. So wurden auch<br />

während der Zeit des harten Lockdowns alle Tumoroperationen ebenso wie<br />

septische Eingriffe entsprechend der Notwendigkeit durchgeführt. Unter<br />

Berücksichtigung der Dringlichkeitsabstufung wurden Patientinnen und<br />

Patienten mit chronischen Erkrankungen ohne dringenden medizinischen<br />

Handlungsbedarf aufgeschoben und nach Ende des Lockdowns, spätestens<br />

mit 1. Juni <strong>2020</strong>, als alle Ressourcen wieder zu 100 Prozent zur Verfügung<br />

standen, bis zum Herbst operativ versorgt. Erfreulicherweise haben viele<br />

nicht dringliche Patientinnen und Patienten aufgrund der allgemeinen<br />

Verunsicherung und der Schwierigkeiten in der Nachbehandlung ihre<br />

Operationstermine bereits auf einen späteren Zeitpunkt verschoben.<br />

Welche Leistungen/Operationen bietet nur die Universitätsklinik für<br />

Orthopädie und Unfallchirurgie an, die sonst kaum oder gar nicht in<br />

Österreich gemacht werden können?


<strong>Klinik</strong><br />

11<br />

Neben der Polytrauma-Versorgung im unfallchirurgischen Bereich, die auf<br />

wenige Trauma-Zentren konzentriert ist, sind es vor allem komplexe Tumoroperationen<br />

und rekonstruktive Eingriffe im Bereich der Extremitäten und<br />

der Wirbelsäule. Hierunter fallen komplexe Gliedmaßenfehlbildungen wie<br />

Skolioseoperationen und En-bloc-Resektionen an der Wirbelsäule bei primär<br />

malignen Knochentumoren. Als tertiäres Versorgungszentrum sind wir auch<br />

die einzige Anlaufstelle für alle multimorbiden Patientinnen und Patienten,<br />

die sonst nirgendwo zur Operation aufgenommen werden.<br />

„Auch während der Zeit des harten<br />

Lockdowns in der Corona-Krise wurden<br />

alle Tumoroperationen ebenso<br />

wie septische Eingriffe entsprechend<br />

der Notwendigkeit durchgeführt.“<br />

Reinhard Windhager<br />

Hat sich die Krise auch auf die <strong>Forschung</strong>stätigkeit ausgewirkt?<br />

Die Zeit des Lockdowns hat sicherlich mehr Möglichkeiten geboten, Studien<br />

die bereits durchgeführt oder in Ausarbeitung waren, fertigzustellen und<br />

abzuschließen. Andererseits konnten interessante Konzepte für weitere Studien<br />

in dieser Zeit geboren werden. Dank dem Einsatz aller Mitarbeiterinnen<br />

und Mitarbeiter wurden prospektiv randomisierte Studien nur geringgradig<br />

in Bezug auf Rekrutierung während des Lockdowns beeinträchtigt, jedoch<br />

insgesamt nicht unterbrochen.<br />

Welche herausragenden <strong>Forschung</strong>sgebiete sehen Sie – in der Gegenwart,<br />

aber auch in der Zukunft?<br />

Entsprechend dem allgemeinen Trend der Personalisierung konzentrieren<br />

wir uns seit längerer Zeit nicht nur auf die Individualisierung von Behandlungskonzepten,<br />

sondern auch auf die differenzierte Planung und Durchführung<br />

von Operationen im Rahmen des institutionsübergreifenden Projektes<br />

des 3D-Druckverfahrens, das sowohl für Kunststoff als auch Metalle an der<br />

Universität umgesetzt werden kann. Weiter ausgebaut werden auch die Analyse<br />

von Biomarkern als Prognosefaktoren im Polytrauma-Management, die<br />

Anbindung verschiedenster differenzierter bildgebender Verfahren inklusive<br />

der biochemischen Bildgebung und das zukunftsträchtige <strong>Forschung</strong>sgebiet<br />

der Biochip-Technologie, mit der organtypische, gewebsähnliche Mikrosysteme<br />

als dreidimensionales Krankheitsmodell des Gelenkes dargestellt<br />

werden können und die degradative sowie inflammatorische Prozesse<br />

simulieren lässt.<br />

Wie liegt die MedUni bei der <strong>Forschung</strong> im internationalen Vergleich?<br />

Der wissenschaftliche Output der MedUni Wien kann der Homepage<br />

entnommen werden und ist mehr als beeindruckend. Auch in unserem<br />

Bereich ist eine kontinuierliche Zunahme des wissenschaftlichen Out -<br />

puts über die letzten Jahre und entsprechend der Zunahme der Impact-<br />

Faktoren auch ein kontinuierlicher Anstieg der Qualität der publizierten<br />

<strong>Forschung</strong>sergebnisse zu verzeichnen. Direkte Vergleiche mit anderen<br />

Institutionen sind nur schwer möglich, da die Ergebnisse öffentlich nur<br />

als Gesamtergebnis wiedergegeben werden und somit ein direktes<br />

Benchmarking verunmöglichen.<br />

Welche Kooperationen gibt es mit Firmen bzw. anderen <strong>Klinik</strong>en?<br />

Die Interaktion mit verschiedenen <strong>Klinik</strong>en ist durch die zahlreichen<br />

klinischen Boards bestens etabliert und im Alltag vollkommen integriert.<br />

Aus diesen klinischen Kooperationen, die alle wesentlichen Schwerpunkte<br />

der <strong>Klinik</strong> betreffen, ergeben sich zahlreiche Fragestellungen und damit<br />

Ansatzpunkte für neue <strong>Forschung</strong>sprojekte. Die Kooperationen mit den<br />

Firmen sind jahrelang etabliert, wobei für neue, interessante Aspekte<br />

weiterhin Platz sein wird.


<strong>Klinik</strong><br />

12<br />

Wie wirkt sich die <strong>Forschung</strong> auf die Patientinnen und Patienten aus?<br />

Entsprechend unserem Zugang als klinische Wissenschaftler ergeben sich<br />

die Fragestellungen aus dem klinischen Alltag, sodass die Ergebnisse in<br />

jedem Fall als klinisch relevant bezeichnet werden können und somit Auswirkungen<br />

auf klinische Entscheidungsprozesse oder Behandlungsmodalitäten<br />

von Patientinnen und Patienten haben.<br />

Wie haben sich die Änderungen in der Ausbildung an der <strong>Klinik</strong> etabliert?<br />

Durch die Umsetzung des neuen Ausbildungscurriculums ist eine intensivere<br />

Verbindung der beiden klinischen Abteilungen für Orthopädie und<br />

Unfallchirurgie eingetreten. Einzig und allein die hohe Vorhaltekapazität,<br />

welche durch die für den Akutbereich notwendige personelle Vorhaltekapazität<br />

der Unfallchirurgie bedingt ist, bewirkt ein Missverhältnis in der<br />

Rotation, sodass vereinzelt Teile der orthopädischen Ausbildungszeit an<br />

einer auswärtigen Institution verbracht werden müssen. Diesem Umstand<br />

kann allerdings durch die Notwendigkeit eines Auslandsaufenthaltes,<br />

der als Voraussetzung für eine klinische Karriere von der MedUni vorgeschrieben<br />

ist, Rechnung getragen werden.<br />

„Entsprechend dem allgemeinen Trend<br />

der Personalisierung konzentrieren<br />

wir uns seit längerer Zeit nicht nur auf<br />

die Individualisierung von Behandlungskonzepten,<br />

sondern auch auf die<br />

differenzierte Planung und Durchführung<br />

von Operationen im Rahmen des<br />

institutionsübergreifenden Projektes<br />

des 3D-Druckverfahrens, das sowohl<br />

für Kunststoff als auch Metalle an der<br />

Universität umgesetzt werden kann.“<br />

Reinhard Windhager<br />

Welche Ausbildungsinhalte sind für Sie wichtig?<br />

Die an unserer Universitätsklinik in Ausbildung Stehenden haben die einzigartige<br />

Möglichkeit, seltene Erkrankungen und komplizierteste Behandlungen<br />

in hoher Frequenz zu sehen, wodurch das Spektrum der Ausbildung wesentlich<br />

vergrößert wird.<br />

Wie wichtig ist die Zertifizierung zum Endoprothetikzentrum mit<br />

Maximalversorgung für die <strong>Klinik</strong>?<br />

Die frühere Universitätsklinik und jetzige klinische Abteilung für Orthopädie<br />

wurde als erstes Zentrum in Österreich zertifiziert und anerkannt.<br />

Die dadurch eingetretene Steigerung der Behandlungsqualität sollte<br />

eigentlich keiner Patientin, keinem Patienten vorenthalten werden, sodass<br />

zu fordern ist, dass eine flächendeckende Zertifizierung forciert wird.<br />

Patientinnen und Patienten haben das Recht, in transparenter Form über<br />

Behandlungserfolge informiert zu werden und darauf pochen zu können,<br />

dass das Minimum an Operationsfrequenz für die Durchführung des bevorstehenden<br />

Eingriffs zur Verfügung steht. Dies betrifft in weiterer Folge<br />

auch Revisionen, die ab einem gewissen Grad an ein Zentrum überwiesen<br />

werden sollten, um der Patientin, dem Patienten die maximale Behandlungsoption<br />

bieten zu können.<br />

Welche Fortschritte hat die Endoprothetik in den letzten Jahren gemacht?<br />

Neben einigen relevanten Neuerungen in der Implantologie, die sich auch<br />

klinisch ausgewirkt haben, sind es vor allem die verbesserte Planung und<br />

Planungsmöglichkeit der Endoprothetik mit entsprechender differenzierter<br />

Umsetzung, aber auch neue Methoden, wie die 3D-Drucktechnologie,<br />

die vor allem bei individuell angefertigten Prothesen im Beckenbereich Anwendung<br />

findet und durch neue Modifikationen eine deutlich verbesserte<br />

Osteointegration ermöglicht. Durch diese verschiedenen Differenzierungen<br />

sind jedoch mehr Fragen als Lösungen aufgetaucht, die die <strong>Forschung</strong><br />

enorm beflügelt haben.


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Das ÄrztInnenteam<br />

14<br />

Die Expertinnen und<br />

Experten auf einen Blick<br />

Neben dem Fortschritt in der Medizintechnik und innovativen<br />

Medikamenten sind vor allem die Mitarbeiterinnen und Mitarbeiter<br />

ein essenzieller Garant für den optimalen medizinischen<br />

Erfolg. Die rund 100 Ärztinnen und Ärzte der Universitätsklinik<br />

für Orthopädie und Unfallchirurgie im AKH Wien profitieren<br />

dabei auch vom exzellenten Netzwerk, dem wertschätzenden<br />

Umgang miteinander und der zielorientierten, individuellen<br />

Fort- und Weiterbildung.


Das ÄrztInnenteam<br />

15<br />

Universitätsklinik für Orthopädie und Unfallchirurgie<br />

Leiter: o. Univ.-Prof. Dr. Reinhard Windhager<br />

Klinische Abteilung für Orthopädie<br />

o. Univ.-Prof. Dr. Reinhard Windhager<br />

ao. Univ.-Prof. in Dr. in Catharina Chiari, MSc<br />

Univ.-Prof. Dr. Alexander Giurea<br />

Klinische Abteilung für Unfallchirurgie<br />

Assoz. Prof. Priv.-Doz. Dr. Stefan Hajdu, MBA<br />

Assoz. Prof. in Priv.-Doz. in Dr. in Silke Aldrian<br />

Mitarbeiterinnen und Mitarbeiter:<br />

(in alphabetischer Reihenfolge)<br />

Dr. Lukas Albrecht<br />

Dr. Jürgen Alphonsus<br />

Dr. in Anna Antoni<br />

Dr. Sebastian Apprich<br />

Univ.- Prof. in Dr. in Michaela Auer-Grumbach<br />

Mag. a Dr. in Rita Babeluk<br />

Dr. Sebastian Bachl<br />

Dr. Oskar Bamer<br />

Dr. in Elena Batrina<br />

DI Dr. Emir Benca<br />

Mag. a Marilena Bertacco<br />

Dr. Harald Binder<br />

Priv.-Doz. DDr. Christoph Böhler<br />

Dr. Robert Breuer (karenziert)<br />

Dr. Alexander Bumberger<br />

Dr. in Miroslava Cernakova<br />

Dr. in Britta Chocholka (karenziert)<br />

Dr. in Theresia Dangl<br />

Dr. Michél Dedeyan (karenziert)<br />

Dr. Stephan Döring<br />

Dr. in Nevenka Drmic<br />

Dr. Alexander Egkher<br />

Dr. Lukas Eichelberger<br />

Dr. Jozsef-Tibor Erdös<br />

Dr. in Emilia Eredansky<br />

Mag. a Seyma Ergün<br />

Dr. Georg Fraberger<br />

Dr. Stephan Frenzel<br />

Ass.-Prof. Dr. Martin Frossard (Internist)<br />

Assoz. Prof. Priv.-Doz. Dr. Philipp Funovics, MSc<br />

Dr. Markus Gregori<br />

Ass.-Prof. Dr. Manfred Greitbauer<br />

Univ.-Prof. Dr. Josef Grohs<br />

Dr. in Luiza Grünberg<br />

Dr. Thomas Haider, PhD<br />

Dr. Gabriel Halát<br />

Dr. in Martina Hamböck<br />

Dr. in Martina Hauser-Shinhan<br />

ao. Univ.-Prof. Dr. Thomas Heinz<br />

Dr. Stephan Heisinger<br />

Priv.-Doz. Dr. Gerhard Hobusch, MSc<br />

Assoz. Prof. Priv.-Doz. Dr. Marcus Hofbauer<br />

Dr. Florian Hofmann<br />

Dr. in Katharina Hohenstein-Scheibenecker<br />

Dr. in Sabrina Holzer, BA (karenziert)<br />

Dr. in Laura Hruby, PhD<br />

Dr. Florian Hruska<br />

Dr. Zhaohui Hu<br />

Dr. Michael Humenberger<br />

Dr. in Manuela Jaindl<br />

Dr. in Nina Janjic<br />

Dr. Nikolaus Jantsch<br />

Dr. Fatmir Kabashi<br />

Dr. Georg Kaiser<br />

Priv.-Doz. Dr. Maximilian Kasparek, MSc<br />

Univ.-Prof. Dr. Richard Kdolsky<br />

Dr. in Anne Kleiner<br />

Priv.-Doz. Dr. Alexander Kolb<br />

Dr. Paul Kolbitsch<br />

Dr. Ulrich Koller, MSc<br />

Dr. in Irena Krusche-Mandl<br />

Assoz. Prof. Priv.-Doz. Dr. Bernd Kubista, MSc<br />

Dr. in Roberta Laggner<br />

Dr. Nikolaus Lang, MSc<br />

Priv.-Doz. Dr. Richard Lass, MSc<br />

Assoz. Prof. Priv.-Doz. Dr. Johannes Leitgeb<br />

Dr. in Monika Luxl<br />

Ass.-Prof. Dr. Wolfgang Machold<br />

Dr. Bernhard Maier<br />

Dr. in Ulrike Marquart<br />

Dr. Michael Matzner<br />

Dr. Timon Moftakhar<br />

Dr. in Claudia Müller<br />

Priv.-Doz. Dr. Lukas Negrin, PhD, MSc<br />

Dr. Georgios Neophytou<br />

Dr. Arastoo Nia<br />

Dr. in Sylvia Nürnberger<br />

Dr. in Karin Pagano-Braun<br />

Ass.-Prof. Dr. Gholam Pajenda<br />

Assoz. Prof. Priv.-Doz. Dr. Joannis Panotopoulos<br />

DDr. Stephan Payr<br />

Dr. Stefan Plesser<br />

Dr. in Sigrid Polzer<br />

Dr. Domenik Popp<br />

Priv.-Doz. Dr. Stephan Puchner<br />

Dr. in Colleen Rentenberger<br />

Dr. Gregor Rettl


Das ÄrztInnenteam<br />

16<br />

Weitere Teammitglieder<br />

DI Dr. in Anna Rienmüller<br />

Dr. Stephan Salzmann<br />

Ass.-Prof. Dr. Klaus-Dieter Schatz<br />

Dr. Philip Schefzig<br />

Dr. Philipp Scheider<br />

Dr. in Eleonora Schneider<br />

Dr. Markus Schreiner<br />

Dr. Rupert Schuster<br />

Dr. Gilbert Schwarz<br />

Ass.-Prof. in Dr. in Elisabeth Schwendenwein<br />

Dr. Florian Sevelda, MSc<br />

Dr. in Irene Sigmund<br />

Ass.-Prof. Dr. Gobert Skrbensky<br />

Dr. Bernhard Springer<br />

Dr. Kevin Staats<br />

Dr. in Julia Starlinger, PhD (karenziert)<br />

Dr. in Beate Stelzeneder<br />

Dr. in Sandra Stenicka (karenziert)<br />

Priv.-Doz. Dr. Christoph Stihsen<br />

Ass.-Prof. Dr. Walter Stoik<br />

Dr. in Geraldine Sturz<br />

Dr. in Gerhild Thalhammer<br />

Dr. Thomas Tiefenböck, MSc<br />

Assoz. Prof. Priv.-Doz. Mag. Dr. Stefan Toegel<br />

Dr. Klemens Vertesich<br />

Dr. Rainer Wagner<br />

Ap. Prof. Priv.-Doz. Dr. Wenzel Waldstein-Wartenberg<br />

Dr. in Valerie Weihs<br />

Priv.-Doz. Dr. Harald K.Widhalm<br />

Dr. in Madeleine Willegger<br />

ao. Univ.-Prof. Dr. Gerald E. Wozasek<br />

Dr. Lukas Zak<br />

Dr. in Cornelia Zeitler<br />

Mag. a Dominika Zurawaska<br />

GastärztInnen und Beobachter im Jahr <strong>2020</strong><br />

Dr. Jamal Abdel-Karim Al-Omari,<br />

Dr. Chang-Bae Kong


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Das ÄrztInnenteam<br />

18<br />

Wiener Gesundheitsverbund<br />

Teilunternehmung AKH Wien<br />

Universitätsklinik für<br />

Klinische Abteilung für Orthopädie<br />

PatientInnenversorgung<br />

<strong>Forschung</strong><br />

Spezialambulanzen<br />

Schulter und Ellbogen<br />

Sportchirurgie Knie<br />

Hand<br />

Fuß<br />

Orthopädische<br />

Schmerzambulanz<br />

Hüfte<br />

Knie<br />

Knorpelschäden<br />

Neuromuskuläre<br />

Fussamb.<br />

Patellofemoral<br />

Knochen- und<br />

Weichteilsarkome<br />

Klumpfuß<br />

Extremitätendeformität<br />

Spezialteams<br />

Sportorthopädie<br />

Rheumaorthopädie<br />

Rehabilitation<br />

und Prothetik<br />

Komplexe Revision und<br />

Extremitätenrekonstruktionen<br />

Endoprothetik<br />

Kinderorthopädie<br />

Tumororthopädie<br />

<strong>Forschung</strong>scluster<br />

Arthrose und<br />

Geweberegeneration<br />

Deformitäten und<br />

Frakturheilung<br />

Endoprothetik<br />

Hand<br />

Infektionen<br />

Kinder<br />

Neuropathien<br />

Poly- und Schädelhirntrauma<br />

Sport und Gelenkserhaltung<br />

Tumor<br />

Spezielle<br />

biomedizinischtechnische<br />

Verfahren<br />

3D OP<br />

Ganganalyse<br />

MRT und biochemische<br />

Bilddiagnostik<br />

PROMS/RDA<br />

Rapid Prototyping<br />

RSA<br />

Skoliose und WS-<br />

Deformitäten<br />

Wirbelsäule<br />

Wirbelsäule


Das ÄrztInnenteam<br />

19<br />

Medizinische Universität Wien<br />

Orthopädie und Unfallchirurgie<br />

Klinische Abteilung für Unfallchirurgie<br />

Lehre<br />

PatientInnenversorgung<br />

Orthopädie<br />

Studierendenausbildung<br />

im Diplom- und<br />

Doktoratsstudium<br />

Unfallchirurgie<br />

Diplom- und<br />

Doktoratsstudium<br />

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+<br />

Nachbehandlungsambulanz<br />

Spezialambulanzen<br />

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Weiterbildung<br />

inkl. PhD<br />

Facharztausbildung<br />

Postgraduelle Aus-/<br />

Weiterbildung<br />

inkl. PhD<br />

Facharztausbildung<br />

Wirbelsäulenverletzungen<br />

Traumatische Knorpelschäden<br />

Posttraumat. Deformitäten<br />

und Gliedmaßenrekonstruktion<br />

Kindertraumatologie<br />

Sportambulanz<br />

Handambulanz<br />

Schulterambulanz<br />

Hüftambulanz


Ambulanzen<br />

20<br />

Ambulanzverzeichnis der<br />

Universitätsklinik für<br />

Orthopädie und Unfallchirurgie<br />

Alle Spezialambulanzen der Klinischen Abteilung für Ortho pädie<br />

befinden sich auf Ebene 7D im AKH Wien unter dem grünen<br />

Bettenhaus und werden als Bestellambulanz geführt (telefonische<br />

Terminvereinbarung unter +43/1/404 00-40800). Die Zuweisung<br />

der Patientinnen und Patienten erfolgt durch die niedergelassenen<br />

Fachärztinnen und -ärzte für Orthopädie. Die Spezialambulanzen<br />

der Klinischen Abteilung für Unfall chirurgie und die Nachbehandlung<br />

in der Unfallambulanz sind auf Ebene 6 angesiedelt<br />

(telefonische Terminvereinbarung unter +43/1/404 00-59380).


Ambulanzen<br />

21<br />

Spezialambulanzen Klinische Abteilung für Orthopädie<br />

Spezialambulanz für orthopädische Schmerztherapie<br />

Endoprothesenzentrum der Maximalversorgung<br />

• Spezialambulanz für Endoprothetik<br />

• Spezialambulanz für Knie<br />

• Spezialambulanz für Hüfte<br />

• Spezialambulanz für komplexe Revisionen und Extremitätenrekonstruktionen<br />

Tumororthopädie<br />

• Spezialambulanz für Tumororthopädie<br />

• Spezialambulanz für Knochen- und Weichteilsarkome<br />

• Spezialambulanz für Rehabilitation und Prothetik<br />

Wirbelsäulenorthopädie<br />

• Spezialambulanz für Wirbelsäule<br />

• Spezialambulanz für Skoliose und Wirbelsäulendeformitäten<br />

Kinderorthopädie<br />

• Spezialambulanz für Kinderorthopädie<br />

• Spezialambulanz für Knorpelschäden<br />

• Spezialambulanz für Klumpfuß<br />

• Spezialambulanz für Extremitätendeformitäten<br />

• Neuromuskuläre Fußambulanz<br />

Rheumaorthopädie<br />

• Spezialambulanz für Rheumaorthopädie<br />

• Spezialambulanz für Fuß<br />

• Spezialambulanz für Hand<br />

Sportorthopädie<br />

• Spezialambulanz für Sportorthopädie<br />

• Spezialambulanz für Sportchirurgie Knie<br />

• Spezialambulanz für Schulter und Ellbogen<br />

Spezialambulanzen Klinische Abteilung für Unfallchirurgie<br />

• Allgemeine Unfallambulanz – Erstversorgung<br />

• Allgemeine Unfallambulanz – Nachbehandlung<br />

• Ambulanz für Kindertraumatologie<br />

• Ambulanz für Handchirurgie<br />

• Ambulanz für Hüftverletzungen und posttraumatische Hüftbeschwerden<br />

• Schulterambulanz<br />

• Ambulanz für traumatische Knorpelschäden<br />

• Ambulanz für posttraumatische Deformitäten und Gliedmaßenrekonstruktion<br />

• Ambulanz für Sportverletzungen<br />

• Ambulanz für posttraumatische Wirbelsäulenbeschwerden


TOP-Studien<br />

22<br />

Quantitative Biochemical MRI<br />

of Hyaline Cartilage<br />

„Our study demonstrated that T2<br />

mapping enables the quantification<br />

of patellar cartilage defect progression<br />

in untreated defects over time,<br />

[indicating its potential as a]<br />

predictive marker of patellar<br />

cartilage degeneration.“<br />

Sebastian Apprich<br />

The department of Orthopedic and Trauma Surgery at the Medical<br />

University of Vienna has conducted a successful interdisciplinary<br />

collaboration with the onsite High Field MR Centre of Excellence<br />

of Prof. Trattnig for years. A major goal is the implementation and<br />

improvement of new imaging techniques to explore the natural<br />

course of cartilage defects and its potential repair techniques.<br />

As a result of this collaboration the article „Potential predictive value of<br />

axial T2 mapping at 3 Tesla MRI in patients with untreated patellar cartilage<br />

defects over a mean follow-up of four years“ was published in the Journal of<br />

Osteoarthritis and Cartilage in <strong>2020</strong>. Magnetic resonance imaging (MRI), with<br />

its high spatial resolution and its capability for superior soft tissue contrast,<br />

represents the gold standard for diagnosis of incipient osteoarthritis, the<br />

follow up of its natural course, and the treatment options.<br />

High resolution MRI and newly developed semi-quantitative scoring systems<br />

allow for the morphological assessment of the whole joint in patients<br />

with Osteoarthritis (OA) (e.g. MOAKS (MRI Osteoarthritis Knee Score) and<br />

in patients after surgical cartilage repair (Whole joint MRI assessment of<br />

surgical cartilage repair of the knee: cartilage repair osteoarthritis knee<br />

score (CROAKS)). Additionally, new imaging techniques (T2/T2* Mapping,<br />

dGEMRIC, Sodium Imaging, gagCEST Imaging, …) have evolved over the<br />

recent year, which enable a deeper sight into the compositional structure<br />

of hyaline cartilage itself.<br />

Study:<br />

Apprich SR, Schreiner MM,<br />

Szomolanyi P, Welsch GH, Koller<br />

UK, Weber M, Windhager R,<br />

Trattnig S. Potential predictive<br />

value of axial T2 mapping at<br />

3 Tesla MRI in patients with<br />

untreated patellar cartilage<br />

defects over a mean follow-up<br />

of four years. Osteoarthritis<br />

Cartilage. Osteoarthritis Cartilage.<br />

<strong>2020</strong> Feb;28(2):215–222<br />

Advantages of T2 Mapping<br />

T2 mapping has proven the capability to gain information about water<br />

content and structure of the collagen fiber network of hyaline cartilage<br />

by assessment of quantitative T2 relaxation times. For several reasons, T2<br />

mapping provides some major advantages over other techniques. On one<br />

hand it is relatively independent from the available field strength of the MRI<br />

scanners and can be performed using a 1.5 Tesla scanner and upwards, on<br />

the other hand it does not require the administrations of a contrast agent<br />

and is feasible within a reasonable scan time.<br />

Within the aforementioned publication, we demonstrated the potential of<br />

axial T2 mapping for quantification of untreated early-stage patellar cartilage<br />

lesions over time and assessed its capability as a potential predictive<br />

marker for future progression. Our study cohort consisted of thirty patients<br />

(mean age, 36.7 ± 11.1 years; 16 males), with early-stage patellar cartilage


TOP-Studien<br />

23<br />

defects (≤ International cartilage repair Society (ICRS) grade 2) at baseline<br />

and no surgical or invasive treatment during the follow up (4.0 ± 1.6 years).<br />

To ensure the technical consistency especially of the T2 mapping, hardware,<br />

including the MR scanner and the knee coil, as well as the MR sequence<br />

protocol, was identical for all subjects at both time points.<br />

Following the ICRS grading system, morphological cartilage changes over<br />

time were subdivided into a progression group, a non-progression group and<br />

regression group. Quantitative analysis of cartilage defects was performed<br />

by means of global and zonal T2 mapping (deep and superficial cartilage T2<br />

values) at both time points.<br />

Figure 1:<br />

A 34-year-old female patient with an ICRS<br />

grade 1 cartilage defect of the lateral facet on<br />

high-resolution axial PD TSE morphological<br />

image at baseline MRI. The corresponding axial<br />

T2 map verifies a significant increase in global<br />

cartilage T2 values. Furthermore, on the medial<br />

apex of the T2 map, a punctual increase of T2<br />

values can be seen at the superficial layer,<br />

whereas the morphological image seems to<br />

prove that the cartilage is intact (A). At follow<br />

up after 3 ½ years (B), the morphological image<br />

showed a progression of the cartilage defect,<br />

not only for the lateral facet, but also for the<br />

medial apex. The corresponding T2 map shows<br />

a significant increase.


TOP-Studien<br />

24<br />

Figure 2:<br />

A 42-year-old male patient with suspected<br />

cartilage lesion at the apex of the patella on<br />

high-resolution axial PD TSE morphological<br />

image at baseline. The corresponding T2 map<br />

shows a diffuse and slight increase of T2 values<br />

in the same area (A). After 4 years (B), morphological<br />

cartilage status seems to have improved,<br />

together with a decrease of T2 values. The<br />

bisected white frames symbolize typical ROI<br />

placement for zonal assessment of deep and<br />

superficial T2 values.<br />

Results & Conclusions<br />

As a result, we found significantly higher global T2 values at baseline in the<br />

progression group (N = 11; 57.4 ± 7.8 ms), compared to patients without<br />

progression of cartilage defect size (N = 17; 40.6 ± 6.9 ms). Furthermore, the<br />

non-progression group showed only a minor increase in global T2 relaxation<br />

times (43.1 ± 7.9 ms; P = 0.07) at follow up, whereas in the progression group<br />

global (68,7 ± 19 ms; P = 0.02) and superficial T2 values (65,8 ± 8.2–79.8 ±<br />

24.4 ms; P = 0.03) increased significantly. T2 values for healthy reference cartilage<br />

remained stable (Figure 1). Surprisingly, in two patients an improvement<br />

in ICRS grading was observed (regression group), with decreasing T2 values.<br />

The ROC analysis showed an area under the curve of 0.92 (95%CI 0.82–1.0).<br />

At a cut-off value of 47.15 ms, we found a sensitivity of 92% (false-positive<br />

rate of 18%) for future progression of cartilage defects.<br />

Dr. Sebastian Apprich<br />

Author:<br />

Since 2019 Sebastian Apprich<br />

has been a consultant for<br />

Orthopedic and Trauma Surgery<br />

and coordinates the research<br />

activities of the Magnetic<br />

resonance Imaging Cluster.<br />

His clinical interests focus on<br />

joint preserving therapy as well<br />

as hand and foot surgery. As a<br />

result of his expanded research<br />

activities, he has (co)authored<br />

36 pubmed-listed articles and<br />

holds an actual h-index of 17<br />

points (scopus.com).<br />

Taken together, our study demonstrated that T2 mapping enables quantification<br />

of patellar cartilage defect progression in untreated defects<br />

over time. Furthermore, elevated cartilage T2 values at baseline were<br />

associated with longitudinal morphologic degeneration. Within this small<br />

patient cohort with early-stage patellar cartilage defects, T2 mapping<br />

seemed to be a potential predictive marker of patellar cartilage degeneration.<br />

Therefore, this axial T2 mapping sequence, in combination with the<br />

unique characteristics of the patella cartilage (thick cartilage, superficial<br />

and parallel position to the body surface) might be well suited for future<br />

prospective studies to evaluate the natural course of cartilage defects and<br />

their treatment in vivo.<br />

In the Future<br />

Furthermore, our future research will focus to overcome current limitations<br />

of 2-dimensional (2D) multi-echo-spin echo T2 mapping techniques in the<br />

quantitative assessment of hyaline cartilage of the whole joint. Therefore,<br />

further development of 3-D imaging techniques with possibility for multiplanar<br />

reconstruction and, even more important, improvements of the timeconsuming<br />

evaluation process of T2 maps by implementing automated segmentation<br />

techniques in combination with Gray-Level Co-Occurrence Matrix<br />

(GLCM) features will hopefully make quantitative T2 mapping more feasible<br />

for clinical OA-research purposes.


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TOP-Studien<br />

26<br />

Analysis of Running-Related<br />

Injuries: The Vienna Study<br />

„Running-related injuries are multifactorial,<br />

associated with personal data,<br />

training load, anatomic malalignments,<br />

and injury history. While it is impossible<br />

to define a one-fits-all formula to reduce<br />

the risk for RRI in general, runners with<br />

a high risk of a specific injury could be<br />

identified based on patient-specific training<br />

profiles and running gaits, as well as<br />

on pre-existing malalignments […], with<br />

their diagnosis leading to an appropriate<br />

and balanced training adaptation.“<br />

Emir Benca<br />

Most injuries related to running training manifest themselves<br />

during the month of March. Knee injuries are particularly common,<br />

and women seem to injure themselves more often than men. This<br />

was the finding of a study conducted by the MedUni Vienna and<br />

the Orthopädiezentrum Innere Stadt using data from Viennese<br />

runners. The study has recently been published in the Journal of<br />

Clinical Medicine.<br />

According to current surveys, running is one of the favorite sport activities<br />

across the globe. Fourteen percent of Austria’s population, age 15 and older,<br />

are running at least once-, while another 17% are running less than once a<br />

week, but still regularly. Despite the well-known health benefits of regular<br />

running exercises, running is associated with running-related injuries (RRI)<br />

with a yearly incidence of up to 79%. Studies suggest 7.7 running-related<br />

injuries for recreational runners, and 17.8 for novice runners per 1,000 hours<br />

of running, and the vast majority of them are related to overuse. The aims of<br />

this study were the presentation of a heterogeneous running population with<br />

running-related injuries, the analysis of a broad range of potential contributing<br />

factors for most common RRIs and their combinations, and the investigation<br />

if different running footwear categories affect injury incidences.<br />

Study:<br />

Benca E, Listabarth S, Flock<br />

FKJ, Pablik E, Fischer C,<br />

Walzer SM, Dorotka R, Windhager<br />

R, Ziai P. Analysis of<br />

Running-Related Injuries:<br />

The Vienna Study. J Clin Med.<br />

<strong>2020</strong> Feb 6;9(2):438<br />

Methods & Data<br />

Using a thorough questionnaire in combination with malalignment and injury<br />

data, a detailed description of a large population with running-related injuries<br />

was presented. The running population is characterized by its heterogeneity, a<br />

long running history, and a detailed description of the training data. The presentation<br />

of the number of injured runners over the months shows a normal distribution<br />

with a peak in March (Figure 1). An increase was observed during the<br />

early winter months. This observation coincides with the onset of the „Vienna<br />

City Marathon“, the largest national running event with over 40,000 participants,<br />

which is held on the second weekend in April each year. While there<br />

is no evidence that participating in long-distance races is associated with<br />

overuse injuries, the presented data suggest that the accompanying increase<br />

in training load must occur incrementally and include regeneration periods.<br />

The observed injuries came exclusively from overuse. 178 patients suffered<br />

from 244 injuries with 44 specific diagnoses, 45 were secondary injuries<br />

to the one and same location. The injuries were mainly located at the knee<br />

(41.2%), followed by the ankle joint (15.0%), and the foot (10.6%). Most<br />

common were the patellofemoral pain syndrome (PFPS) (13.4%), the iliotibial


TOP-Studien<br />

27<br />

5<br />

5<br />

Patients (-)<br />

10 15 20 25 30<br />

Injury frequenca (-)<br />

10 15 20<br />

Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep<br />

PFPS<br />

ITBFS Patellar tendinopathy Spinal injuries Ankle instability<br />

Figure 1: Month of presentation.<br />

Figure 2: Distribution of most common RRIs across sexes and age groups.<br />

band friction syndrome (ITBFS) (12.3%), patellar tendinopathy (12.3%), spinal<br />

injuries (11.2%), and instability of the ankle joint (8.4%) (Figure 2).<br />

Results<br />

The authors evaluated the association between the following factors: sex, age,<br />

height, BMI, activity history, weekly activity hours, weekly mileage, weekly frequency,<br />

as well as individual training habits (e.g. warming up, stretching) and<br />

various anatomic malalignments with the five most common injury locations<br />

including most common specific injuries in these sites. Knee injuries were positively<br />

associated with lower BMI, and previous injury with similar complaints<br />

as well as with malalignments (knee malalignment, especially varus knee,<br />

and pes planus). The patellofemoral pain syndrome was positively associated<br />

with lower training frequency, knee malalignment, and with lower height. The<br />

iliotibial band friction syndrome showed a positive association with previous<br />

injury and a negative association with BMI. Patients with patellar tendinopathy<br />

had a lower BMI, showed a lower running pace, but more often knee and less<br />

often hip malalignments than the others. Patients with injuries at the foot/<br />

ankle reported less often a history of similar previous injuries and showed<br />

a negative association with knee malalignment and pes planus, while ankle<br />

instability was positively associated with weekly activity and pes cavus. Hip/<br />

pelvis patients showed a positive association with running experience, scoliosis,<br />

and patellar squinting, and a negative one with stretching after the run.<br />

Lower back (spinal) injury patients showed a high proportion of scoliosis and<br />

were positively related to higher BMI, but negatively to the varus knee. Injuries<br />

to the lower leg were observed in patients with a higher running pace but had<br />

a negative relationship with malalignment of the knee.<br />

It is important to mention that single variables associated with a specific injury<br />

or injury location must not be regarded as isolated contributing factors.<br />

A RRI is the result of multiple associated factors in terms of anthropometrics<br />

and malalignments in combination with previous injury history and exposure<br />

to certain training load. None of the sustained RRI’s is associated with a<br />

single variable only. An injury is sustained when the interaction of predisposing<br />

factors, positive injury history, and a reached threshold in training load<br />

becomes significant. Research questions should not focus on the effect of<br />

single variables on a specific injury, but on specific injuries as a combination<br />

of multiple variables as well as on the weighting of those variables in injury


TOP-Studien<br />

28<br />

prediction models. For example, our data showed BMI to be associated with<br />

multiple injuries or injury sites, however, never as predominant regression<br />

weight, when compared with other significant variables. On the other hand,<br />

the odds to suffer PFPS, patellar tendinopathy or a knee injury in general, are<br />

much higher in patients with knee malalignments. In other words, a present<br />

knee malalignment will contribute more to the risk to suffer from a RRI than<br />

BMI does, and therefore shows different clinical relevance. The patients<br />

were not able to provide sufficient data to properly address the question if<br />

different running footwear categories modify injury incidences. Interestingly,<br />

a relatively low proportion of runners with the pes valgus deformity wear<br />

motion-controlled traditional running shoes, even though they are recommended<br />

specifically for them.<br />

DI Dr. Emir Benca<br />

Author:<br />

Emir Benca holds a masters’<br />

degree from TU Wien and a<br />

PhD from Medical University of<br />

Vienna. He is the head of the<br />

Adolf Lorenz Lab for Biomechanics<br />

and coordinates the<br />

rapid prototyping cluster at<br />

the Department of Orthopedics<br />

and Trauma Surgery. He<br />

is currently working at the AO<br />

Research Institute Davos as a<br />

visiting scientist. Dr. Benca has<br />

participated in several half- and<br />

full marathons, as well as the<br />

Ironman 70.3 Austria in 2018.<br />

Sex Discrepancy<br />

A possible sex discrepancy (56% female, 44% male, ratio female: male: 1.25)<br />

was observed in this study, indicating either a generally higher number of<br />

female runners, women consulting a medical doctor sooner, or a higher injury<br />

rate in women than men. While earlier studies showed lower ratios (0.76),<br />

more recent literature shows a higher incidence in female injured runners<br />

(1.16), suggesting that running nowadays is not predominantly a male sport.<br />

Data from a nationwide survey have reported a ratio over the past five years<br />

between female and male Austrians, who run at least once a week, to be<br />

0.78 (range: 0.65 – 0.89). The „Vienna City Marathon” showed a finisher ratio<br />

of 0.52 (range 0.48 – 0.55) for the half- and 0.24 (range 0.22 – 0.28) for the<br />

full marathon (both increasing) over the same period. If the injury incidence<br />

across sexes was equal, the anticipated result would be a higher incidence of<br />

RRIs in men, especially across runners with higher total activity. Those runners<br />

are more likely to participate in long-distance races. However, the sex ratio in<br />

runners in the present study with five or more years of experience was 1.04. To<br />

investigate if there was a difference in visit rates to doctors among sexes, the<br />

patients were asked to indicate how often they visited a doctor per year. Women<br />

reported 2.6 visits, which is 0.35 times more than men, which corresponds to<br />

the well documented average yearly gynecologist visit rate of 0.41, which could<br />

explain the higher rate in medical visits in women. In summary, the female to<br />

male discrepancy seems to be based on a higher injury rate in women rather<br />

than a higher number of female runners in general, a higher participation rates<br />

in race events, or more frequent medical consultations in women.<br />

Conclusion<br />

In conclusion, running-related injuries are multifactorial, associated with<br />

personal data, training load, anatomic malalignments, and injury history. While<br />

it is impossible to define a one-fits-all formula to reduce the risk for RRI in<br />

general, runners with a high risk of a specific injury could be identified based on<br />

patient-specific training profiles and running gaits, as well as on pre-existing<br />

malalignments, such as scoliosis, patellar squinting, knee malalignments,<br />

and/or varus knee, with their diagnosis leading to an appropriate and balanced<br />

training adaptation. Furthermore, awareness of injury risks and prevention<br />

should be raised in running schools and by medical specialists.<br />

In the end, running has remained a popular activity over decades, even though<br />

it has been associated with a high incidence of overuse injuries. By presenting<br />

the injuries the authors did not aim to discourage from running, but to provide<br />

data for better understanding and to contribute to their prevention. We believe<br />

running is still beneficial in many respects, enriching, and simply fun.


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TOP-Studien<br />

30<br />

Rheumatoid Arthritis Disease<br />

Activity and the Risk of Aseptic<br />

Arthroplasty Loosening<br />

Rheumatoid arthritis (RA) is characterised by typical joint inflammation<br />

and synovitis, which, if not treated effectively, leads to joint<br />

destruction and functional disability. Although new treatment<br />

strategies improved long-term outcomes tremendously, rates of<br />

total hip and knee arthroplasty (THA/TKA) in patients with RA<br />

remain considerable.<br />

As RA differs fundamentally from osteoarthrosis (OA) in terms of prognosis,<br />

pathogenesis, and medical treatment, outcomes of total joint arthroplasty<br />

(TJA) and rates of complications would be expected to be different between<br />

these two diseases. Aseptic loosening is the most common cause for surgical<br />

revision after TJA with far-reaching implications, including an exchange of the<br />

implant associated with decreased function, loss of bone stock and an increased<br />

risk for further complications. Reasons for aseptic loosening are not<br />

fully understood, but local inflammation is suspected to play a crucial role.<br />

Systemic inflammation in RA might influence this process of local inflammatory-mediated<br />

osteolysis and could lead to higher aseptic loosening rates<br />

in RA patients, especially in those with increased inflammatory activity. The<br />

objective of this study was to assess the influence of RA disease activity on<br />

the risk of aseptic loosening after TJA. Furthermore, we evaluated if antirheumatic<br />

therapy has an influence on the risk of aseptic loosening. Additionally,<br />

we analysed the rates of radiographic aseptic loosening in OA patients, as a<br />

control group without systemic inflammation.<br />

Study:<br />

Böhler C, Weimann P, Alasti F,<br />

Smolen JS, Windhager R, Aletaha<br />

D. Rheumatoid arthritis<br />

disease activity and the risk of<br />

aseptic arthroplasty loosening.<br />

Semin Arthritis Rheum. <strong>2020</strong><br />

Apr; 50(2):245–251<br />

Patients and Methods<br />

We ascertained data of 49 RA patients who underwent primary TJA with a<br />

fully documented disease activity as well as a complete clinical and radiological<br />

follow-up for analysis. Further we investigated a cohort of OA patient,<br />

who were matched 2:1 for sex, age, date of surgery, and location of TJA as a<br />

control group without systemic inflammation. We obtained demographic data,<br />

comorbidities, antirheumatic therapy results, clinical and functional scores,<br />

duration of surgery, and the type of implant. Due to the restricted number of<br />

revision surgery because of aseptic loosening, we used radiological signs of<br />

component loosening (RCL) as a more sensitive surrogate outcome parameter<br />

for our main analysis. These included radiolucent lines (RLL) with a width<br />

of ≥2mm, osteolysis exceeding 2mm in thickness, and implant migration of<br />

≥2mm. Two independent observers, who were blinded for levels of disease ac-


TOP-Studien<br />

31<br />

Aseptic loosening is the most common<br />

cause for surgical revision after TJA with<br />

far-reaching implications.<br />

„Inflammation in RA patients, as<br />

evidenced by higher levels of disease<br />

activity, increases the risk for radiographic<br />

loosening after TJA. In OA<br />

patients, as a control disease without<br />

systemic inflammation, the risk is<br />

significantly lower.“<br />

Christoph Böhler<br />

tivity and the clinical diagnosis (OA/RA), evaluated the radiographs. Patients<br />

were seen after 6 weeks, 3 and 12 months, and then annually after the TJA.<br />

The Simplified Disease Activity Index (SDAI) was used to determine disease<br />

activity levels. At our rheumatology outpatient clinic, RA patients are followed<br />

every 3 months, and their clinical and laboratory variables are documented<br />

prospectively in an observational database. For statistical analysis we<br />

performed Cox regression to estimate RCL based on SDAI, adjusting for the<br />

anti-rheumatic therapy (conventional vs. biological disease modifying drugs,<br />

DMARDs). Furthermore, we compared the rates of aseptic loosening and RCL<br />

in RA and OA patients using the Chi-Square-Test, the Kaplan Meier method,<br />

and applied the Log-Rank test to statistically compare survival distributions.<br />

Results<br />

32 patients (65.3%) underwent TKA, and 17 (34.7%) THA. All TKA were<br />

cemented and all THA were fixated cementless. In total 18 (36.7%) showed<br />

signs of RCL. Time integrated SDAI was significantly higher in patients with<br />

RCL (median; 25th and 75th percentile: 10.8; 8.6 and 15.8) than in controls<br />

without RCL (7.0; 2.7 and 15.5) (Figure 1; p=0.043).<br />

When comparing RCL across patient groups in different RA disease activity states,<br />

we found that in the remission group no patient showed signs of RCL (0/10),<br />

whereas in the low and moderate/high disease activity groups 10/21 (47.6%)<br />

and 8/17 (47.1%) patients, respectively, showed signs of RCL (p=0.023). RA<br />

patients receiving biologicals had clearly lower rates of RCL (4/18; 22.2%) compared<br />

to RA patients under traditional DMARD therapy (14/28; 50%). In logistic<br />

regression analyses biologicals significantly reduced the risk of RCL with an<br />

odds ratio (OR) of 0.192 (95% CI 0.042-0.891; p=0.035). The RCL rate was 36.7%<br />

in the RA group and 13.6% in the OA group (p=0.002). This was mainly explained<br />

by a higher rate of RCL in the TKA group (RA: 34.4%; OA: 6.5%; p=0.001), while<br />

the rates in the THA group were only numerically higher in patients with RA<br />

compared to OA (41.2% vs. 30.8%, respectively; p=0.528).<br />

Discussion<br />

The current study for the first time links the risk of aseptic loosening in RA<br />

patients to the level of inflammation with higher disease activity being associated<br />

with more frequent occurrence of radiographic loosening. Biological


TOP-Studien<br />

32<br />

Figure 1: Time integrated SDAI was significantly<br />

higher in patients with RCL (median; 25th and 75th<br />

percentile: 10.8; 8.6 and 15.8) than in controls<br />

without RCL (7.0; 2.7 and 15.5) (Figure 1; p=0.043).<br />

DMARDs had a protective effect on such risk. This link between inflammation<br />

and RCL was further substantiated in the comparison between RA and OA,<br />

being particularly evident for TKA.<br />

Priv.-Doz. DDr. Christoph Böhler<br />

Author:<br />

Christoph Böhler is a specialist<br />

for Orthopaedics and Traumatology<br />

at the Medical University of<br />

Vienna. His clinical and scientific<br />

focus are on primary and<br />

revision arthroplasty. In August<br />

2021 he will start a clinical<br />

Adult Reconstruction Fellowship<br />

at the University of Toronto,<br />

Canada.<br />

Local inflammation plays a pivotal role in the pathogenesis of aseptic loosening,<br />

by which generation of wear debris between the bearing surfaces<br />

leads to activation of macrophages and immune cells, which then release<br />

pro-inflammatory cytokines like TNF-alpha and IL-6. These induce osteoclast<br />

activation and lead to increased bone resorption, osteolysis and eventually to<br />

aseptic loosening. The systemic inflammation of RA may play a role in enhancing<br />

the local inflammation underlying the described processes leading to<br />

aseptic loosening. The implication of these findings for clinical practice are<br />

potentially substantial, at least for individuals with RA and TJA: no patients<br />

in remission showed RCL. Analogously to the observation that in sustained<br />

remission of RA joint damage does not progress, this makes the case that<br />

in the presence of TJA even stricter disease control should be pursued, with<br />

clinical remission being the clear treatment target. Biological DMARDs had<br />

a protective effect on the risk of RCL. Previously, it has been shown that<br />

TNF-inhibitors are able to stop the progression of joint destruction. The<br />

majority of the patients in the biological DMARDs group were treated with<br />

TNF-inhibitors, potentially also suggesting a role of TNF alpha in the mediation<br />

of the inflammatory process leading to aseptic loosening.<br />

Conclusion<br />

Taken together, inflammation in RA patients, as evidenced by higher levels<br />

of disease activity, increases the risk for radiographic loosening after TJA. In<br />

OA patients, as a control disease without systemic inflammation, the risk is<br />

significantly lower. Biological DMARDs may reduce the risk of RCL, although<br />

this would need prospective evaluation. Our data suggest that RA patients<br />

with TJA should regularly undergo orthopaedic and radiographic evaluation<br />

and, in the context of treating RA to target, might be considered for a more<br />

stringent control of disease activity.


Integriertes Patientenversorgungskonzept zur MACT-<br />

Gelenksknorpelrekonstruktion<br />

Exakte Indikationsstellung<br />

Indikations- und Durchführungs empfehlungen<br />

der Arbeits gemeinschaft „Geweberegeneration<br />

und Gewebe ersatz“ zur Autologen<br />

Chondrozyten-Transplanta tion (ACT). Behrens<br />

P, Bosch U, Bruns J, Erggelet C, Esenwein SA, Gaissmaier<br />

C, Krackhardt T, Löhnert J, Marlovits S, Meenen NM,<br />

Mollenhauer J, Nehrer S, Niethard FU, Nöth U, Perka C,<br />

Richter W, Schäfer D, Schneider U, Steinwachs M, Weise K<br />

(2004). Z Orthop 142: 529-539<br />

Hohe Zelldichte und hohe Zellvitalität<br />

des Implantats<br />

Effect of cell seeding concentration on the quality<br />

of tissue engineered constructs loaded with adult<br />

human articular chondrocytes. Concaro S, Nick lasson E,<br />

Ellowsson L, Lindahl A, Brittberg M, Gatenholm P (2008).<br />

J Tissue Eng Regen Med<br />

Flexible Anpassung des Implantats bei<br />

der Trans plantation und Wahrung einer<br />

homogenen Zellmatrix<br />

Stabilization of fibrin-chondrocyte constructs for<br />

cartilage reconstruction. Meinhart J, Fussenegger M, Höbling W<br />

(1999), Ann Plast Surg 42(6): 673-678<br />

Knorpelbiobsat­Entnahme<br />

Zellkultur züchten<br />

MACT­Transplantation<br />

Seit 2001 züchtet das Institut<br />

für Gewebe- und Organrekonstruk<br />

tion, kurz igo®,<br />

autologe Zell kul turen für die<br />

Knorpel zell rekon struk tion für mehr als 1.500 Patienten<br />

erfolgreich an.<br />

igo® ist ein privates biopharmazeutisches Unternehmen<br />

und Pionier auf dem Gebiet der Zellkulturtechnik<br />

und des Tissue Engineerings und aktiv<br />

beteiligt an Entwicklung neuer Heilmethoden. Als<br />

österreichisches Unternehmen glänzen wir mit<br />

der besonderen räumlichen Nähe und dem direkten<br />

Kontakt zu unseren Kunden.<br />

Informieren Sie sich unter www.igor.at<br />

Hohe Compliance des Patienten: Die für<br />

die Nachtherapie verwendeten Geräte,<br />

CPM Schiene sowie HPM Gerät verfügen<br />

über eine Compliance­Überwachung. Wenn<br />

der Patient hier compliant ist, kann man<br />

davon ausgehen, dass er auch bei der<br />

Physio therapie konsequent mitarbeitet, was<br />

für den Erfolg der Therapie wesentlich ist.<br />

Low frequency EMF regulates chondrocyte<br />

differentiation and expression of matrix proteins.<br />

Ciombor DM, Lester G, Aaron RK, Neame P, Caterson B (2002).<br />

J Orthop Res, Vol. 20(1): 40-50<br />

Postoperative Therapie<br />

Die Kontrollierte Nachtherapie: wird<br />

durch das Netz werk von geschulten Physiotherapeuten<br />

unterstützt<br />

MACT­Langzeittherapie<br />

Autologous chondrocyte implantation postoperative<br />

care and rehabilitation. Hambly K, Bobic V, Wondrasch B,<br />

VanAssche D, Marlovits S (2006). Science and Practice.<br />

Am J Sports Med 34(6): 1020-1038<br />

A prospective, randomized comparison of traditional<br />

and accelerated approaches to postoperative<br />

rehabilitation following autologous chondrocyte<br />

implantation: 2-year clinical outcomes. Jay R. Ebert,<br />

William B. Robertson, David G. Lloyd, M.H. Zheng, David J. Wood,<br />

Timothy Ackland (2010). Catilage 1(3)180-187<br />

Wissenschaftliche Publikationen<br />

mit igor Chondro­Systems<br />

Clinical experience with matrix associated<br />

autologous chondrocyte transplantation<br />

(MACT). Ramadani F, Orthner E, Kitzler B,<br />

Wallner B, Burghuber C, Fußenegger M, Meinhart J<br />

(2005). Revista de ortopedie si traumatologie 1(6):<br />

106-110<br />

Transplantation of chondrocytes – longtime<br />

experiments. Prof. Dr. Lars Peterson (2006)<br />

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Patienten bei der Organisation der Nachtherapie.<br />

Informieren Sie sich unter www.leomed.at


TOP-Studien<br />

34<br />

OSTEOGROW: Acceleration<br />

of Bone Healing<br />

Study:<br />

Chiari C, Grgurevic L, Bordukalo-Niksic<br />

T, Oppermann H,<br />

Valentinitsch A, Nemecek E,<br />

Staats K, Schreiner M, Trost C,<br />

Kolb A, Kainberger F, Pehar S,<br />

Milosevic M, Martinovic S, Peric<br />

M, Sampath TK, Vukicevic S,<br />

Windhager R. Recombinant<br />

Human BMP6 Applied Within<br />

Autologous Blood Coagulum<br />

Accelerates Bone Healing:<br />

Randomized Controlled Trial<br />

in High Tibial Osteotomy<br />

Patients. J Bone Miner Res.<br />

<strong>2020</strong> Oct;35(10):1893–1903.<br />

The presented study was undertaken within the OSTEOGROW<br />

collaborative project and has received funding from the European<br />

Union’s Seventh Framework Programme for research, technological<br />

development, and demonstration under grant agreement<br />

No. 279239. The Department of Orthopedics at the Medical University<br />

of Vienna (MUV) served as the study site for the clinical<br />

study on a first in human application of recombinant BMP-6<br />

(bone morphogenic protein – 6).<br />

Prof. Reinhard Windhager (principal investigator) and Prof. Catharina Chiari<br />

(sub-investigator) were the responsible scientists at the MUV. The international<br />

consortium was coordinated by Prof. Slobodan Vukicevic (University of<br />

Zagreb), who is a renowned expert in the field of BMP research.


TOP-Studien<br />

35<br />

Figure 1: Bone mineral density (BMD) measurements.<br />

BMD measured in the wedge of two<br />

groups of high tibial osteotomy (HTO) patients<br />

(autologous bone graft substitute [ABGS] and<br />

placebo [PBO]) from baseline (measured before<br />

the treatment) to weeks 9 and 14 after surgery.<br />

BMD values in the reference cube at baseline<br />

and weeks 9 and 14 after surgery.<br />

„First in human application of rhBMP-6<br />

in high tibial osteotomy for the acceleration<br />

of bone healing.“<br />

Catharina Chiari<br />

The Study<br />

Recombinant human bone morphogenetic proteins (rhBMPs) 2 and 7 have<br />

been used in the treatment of long bone fractures in conjunction with<br />

bovine collagen matrices. They showed side effects like redness and<br />

swelling and induction of osteolysis in cancellous bone, i.e., metayphyis<br />

of the tibia, radius, and hip 1 . Therefore, this project aimed to develop a<br />

rh-BMP-based therapy with a carrier made from autologous blood. This<br />

novel autologous bone graft substitute (ABGS) was composed of rhBMP6<br />

applied within autologous blood coagulum (ABC) 2 . In the present study,<br />

we assessed intraosseal administration of ABGS, i.e., rhBMP (rhBMP6)<br />

loaded within autologous blood coagulum in adult patients who underwent<br />

a high tibial osteotomy (HTO). This study was a randomized, double-blind,<br />

and placebo-controlled phase I/II trial. The primary objective of the study<br />

was to assess safety, tolerability, anti-BMP6 antibody response, if any, and<br />

systemic pharmacokinetics (PK) of the application 100 μg rhBMP6/mL ABC<br />

locally into the wedge gap after osteotomy. The secondary objective was to<br />

assess the acceleration of bone healing in the wedge gap. The total number of<br />

patients enrolled was 20 with a final assignment ABGS/PBO 1:1, 6 included<br />

in phase I and 14 in phase II.


TOP-Studien<br />

36<br />

Figure 2: X-ray images of isolated defect areas<br />

from 2 patients treated with autologous bone<br />

graft substitute (ABGS) or placebo (PBO) from day<br />

1 to month 24. Black arrows shown for the defect<br />

area at month 18 indicate more pronounced BMD<br />

on X-rays of a PBO-treated patient compared with<br />

ABGS. However, at 12 months, still there is a gap<br />

in zone 4 (Z4) for both groups as shown on X-ray<br />

images. At month 24, in the medial site of the gap<br />

for both groups, an incomplete cortical-periosteal<br />

surface restoration after plate removal is indicated<br />

(yellow arrows).<br />

Our Patients<br />

Patients were followed for 0 to 24 months by clinical examination (safety),<br />

computed tomography (CT), and serial radiographic analyses (efficacy) 3 .<br />

The results showed no detectable anti-rhBMP6 antibodies in the blood of<br />

any of the 20 patients at 14 weeks after implantation. During the following<br />

24 months no serious adverse reactions were recorded. The CT scans from<br />

defects of patients treated with rhBMP6/ABC showed an accelerated bone<br />

healing compared with placebo at 9 weeks (47.8 ± 24.1 versus 22.2 ± 12.3<br />

mg/cm 3 ; p = 0.008) and at 14 weeks (89.7 ± 29.1 versus 53.6 ± 21.9 mg/cm 3 ;<br />

p = 0.006) follow-up (Figure 1). Radiographic analyses at weeks 6 and 24 and<br />

months 12 and 24 suggested the advanced bone formation and remodeling<br />

in rhBMP6/ABC-treated patients (Figure 2).<br />

Conclusion<br />

We were able to show that rhBMP6/ABC at a dose of 100 μg/mL accelerates<br />

bone healing in patients undergoing HTO without serious adverse events<br />

and with good tolerability compared with placebo alone. For the first time,<br />

a BMP-based osteogenic implant was examined against a placebo for bone<br />

healing efficacy in the trabecular bone surface, using an objective bone<br />

mineral density measurement system.<br />

ao. Univ.-Prof. in Dr. in Catharina Chiari, MSc<br />

Author:<br />

Catharina Chiari is head of the<br />

Pediatric Orthopedic Team.<br />

Additionally, she has a strong<br />

interest in joint preservation<br />

and regenerative medicine.<br />

Currently she is the president<br />

elect of the Austrian Orthopedic<br />

Society (ÖGO).<br />

References:<br />

1<br />

Vukicevic S, Sampath TK. Bone morphogenetic proteins: systems biology regulators. 1st ed. New<br />

York: Springer International Publishing; 2017.<br />

2<br />

Grgurevic L, Oppermann H, Pecin M, Erjavec I, Capak H, Pauk M, Karlovic S, Kufner V, Lipar M,<br />

Bubic Spoljar J, Bordukalo-Niksic T, Maticic D, Peric M, Windhager R, Sampath TK, Vukicevic S.<br />

Recombinant human bone morphogenetic protein 6 delivered within autologous blood coagulum<br />

restores critical size segmental defects of ulna in rabbits. JBMR Plus. 2019;3(5):e10085.<br />

3<br />

Nemecek E, Chiari C, Valentinitsch A, Kainberger F, Hobusch G, Kolb A, Hirtler L, Trost C, Vukicevic<br />

S, Windhager R. Analysis and quantification of bone healing after open wedge high tibial osteotomy.<br />

Wien Klein Wochenschr. 2019;131(23–24):587–98.


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A Prediction Model for<br />

Total Knee Arthroplasty<br />

A collaborative group of researchers consisting of clinicians,<br />

biostatisticians and anatomists initiated this study in order to<br />

determine patient specific factors that could predict whether a<br />

patient will have to undergo Total Knee Arthroplasty (TKA) within<br />

two years. This work resulted in the establishment of an easily<br />

applicable prediction model based on Artificial Neural Networks<br />

(ANN), as well as in a publication entitled „Predicting Total Knee<br />

Replacement from Symptomology and Radiographic Structural<br />

Change Using Artificial Neural Networks—Data from the Osteoarthritis<br />

Initiative (OAI)“ in the Journal of Clinical Medicine 1 .<br />

As our clinic is a well renowned excellence center for total joint arthroplasty<br />

(EndoCert), we are constantly concerned with improving patient care<br />

by ongoing research. Considering the crucial role of timing of TKA, as well<br />

as the progression of osteoarthritis as the underlying disease, we aimed to<br />

determine factors that could predict TKA two years in advance. In this effort<br />

clinicians from our department teamed up with a biostatistics professor<br />

from Paracelsus Medical University and an anatomy professor from Mayo<br />

Clinic College of Medicine. By using artificial neural networks we succeeded<br />

to establish a prediction model that was able to correctly predict 80%<br />

of the classified individuals to undergo TKA surgery, with a positive predictive<br />

value of 84% and a negative predictive value of 73% 1 .<br />

As commonly known, osteoarthritis of the knee contributes significantly to<br />

the patient’s individual disability and impaired health-related quality of life,<br />

and its treatment imposes a great socioeconomic burden, which is likely to<br />

increase further, as we have shown in a previous study 2 .<br />

Study:<br />

Heisinger S, Hitzl W, Hobusch<br />

GM, Windhager R, Cotofana S.<br />

Predicting Total Knee Replacement<br />

from Symptomology<br />

and Radiographic Structural<br />

Change Using Artificial<br />

Neural Networks-Data from<br />

the Osteoarthritis Initiative<br />

(OAI). J Clin Med. <strong>2020</strong> May<br />

1;9(5):1298.<br />

Patients and Methods<br />

In this study we included the radiographic and clinical data of 165 patients that<br />

were enrolled in the Osteoarthritis Initiative study, representing a well-established<br />

database for osteoarthritis research, which is accessible at nda.nih.gov 3 .<br />

Patient data were analyzed longitudinally and changes were identified as<br />

shown in Figure 1 (WOMAC total: 9.7 95% CI (7–12.5), p = < 0.0001; WOMAC<br />

pain subscore: 0.5 (1.5–3), p = < 0.0001; quality of life 9.4 (6.3–12.6), p = <<br />

0.0001; and pain intensity 1.5 (1–2), p = < 0.0001 ). While the radiographic<br />

status constantly worsened between the timepoints prior to TKA, the symptomology<br />

started to significantly worsen 1 year before surgery. In order to<br />

develop a prediction model we used Artificial neural networks (ANNs) 1 .


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Figure 1: Longitudinal change of WOMAC totalscore, WOMAC pain subscore,<br />

quality of life and pain intensity.<br />

„Our model is based on easily accessible<br />

patient data, making it easily applicable<br />

in a primary care setting to evaluate the<br />

need for TKA surgery within the next<br />

two years and to give the patient an idea<br />

about their status quo.“<br />

Stephan Heisinger<br />

In total 14 variables were included, and the most predictive group consisting<br />

of pain intensity, Kellgren and Lawrence grades, WOMAC total score, use of<br />

pain medication, and body mass index was identified by the integrated neural<br />

network variable selection algorithm to have the best outcome performance<br />

for predicting TKA surgery within 2 years. Furthermore, more than 250 neural<br />

networks models with different network architecture were created, tested,<br />

and protected against overlearning by splitting the patient sample into a<br />

training, a verification, and a test sample, and monitored accordingly (ratio<br />

2:1:1). We used two prediction thresholds for acceptance and for rejection,<br />

i.e., if data of a subject fall into this area, no prediction is made. All analyses<br />

were done using PASW 22 (IBM SPSS Statistics for Windows, Version 19.0.,<br />

Armonk, NY, USA), StatXact 10 (Cytel Software 2013, Cambridge MA, USA),<br />

Mathematica 7 (Wolfram Research, Inc., Mathematica, Version 7.0, Champaign,<br />

IL, USA), STATISTICA for neural networks 1.2 and STATISTICA 13 (Hill, T. &<br />

Lewicki, P. Statistics: Methods and Applications. StatSoft, Tulsa, OK, USA) 1 .<br />

After the application of the variable selection algorithm and testing more<br />

than 250 models, KL grades, WOMAC total score, body mass index measures,<br />

pain intensity, and pain medication revealed the following performance: a<br />

negative predictive value of 73% (52–88%), a positive predictive value of<br />

84% (71–94%), and total percentage of correctly predicted knees of 80%<br />

(69–89%) (1). To graphically visualize the neural network output and thereby<br />

our prediction model we created a simplified and easily applicable chart, as<br />

depicted in Figure 2.


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Figure 2: Graphic visualization of the neural network output illustrating the three-layer perceptron decision areas, including the variables pain intensity,<br />

Kellgren and Lawrence grades, WOMAC total score, use of medication (for pain, aching, or stiffness in the knee), and body mass index into the neural<br />

network. Areas represent: green area = no TKA within next 2 years, red area = TKA within next 2 years, and grey area = no prediction is made (1).<br />

Results and Conclusion<br />

Concludingly, our results indicate that significant worsening of pain, function,<br />

and quality of life in the year prior to the TKA seems to be the more dominant<br />

decision driving factor as compared to the radiographic structural changes<br />

of the knee. Furthermore, we were able to establish a model that correctly<br />

predicted 80% of the classified individuals to undergo TKA surgery within the<br />

next 2 years, with a positive predictive value of 84%, and a negative predictive<br />

value of 73% 1 . Our model is based on easily accessible patient data,<br />

making it easily applicable in a primary care setting to evaluate the need for<br />

TKA surgery within the next two years and to give the patient an idea about<br />

their status quo.<br />

Dr. Stephan Heisinger<br />

Author:<br />

Stephan Heisinger completed<br />

his residency at the Department<br />

of Orthopedics and Trauma Surgery<br />

at the Medical University of<br />

Vienna and is currently engaged<br />

in a broad variety of research<br />

fields with a focus on the<br />

application of novel research<br />

tools, such as Artificial Neural<br />

Networks.<br />

References:<br />

1<br />

Walzer SM, Toegel S, Chiari C, Farr S, Rinner B, Weinberg AM, Weinmann D, Fischer MB, Windhager<br />

R.; A three dimensional model of zonally organized cartilaginous matrix in vitro. (in submission)<br />

2<br />

Kolb A, Robinson S, Stelzeneder D, Schreiner M, Chiari C, Windhager R, Trattnig S, Bohndorf K;<br />

Vessel architecture in human knee cartilage in children: an in vivo susceptibility-weighted<br />

imaging study at 7 T; Eur Radiol. 2018 Aug;28(8):3384-3392. doi: 10.1007/s00330-017-5290-1.<br />

Epub 2018 Feb 26.<br />

3<br />

Kolb A, Benca E, Willegger M, Puchner SE, Windhager R, Chiari C.; Measurement considerations on<br />

examiner-dependent factors in the ultrasound assessment of developmental dysplasia of the hip;<br />

Int Orthop. 2017 Jun;41(6):1245–1250.(2)


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tPA Serum Antigen Levels Predict<br />

ARDS in Polytraumatized Patients<br />

Acute respiratory distress syndrome (ARDS) is a highly lifethreatening,<br />

clinically defined, heterogeneous condition, regarding<br />

both etiology and clinical course, which is triggered by<br />

either a direct or an indirect insult to the lung, causing epithelial<br />

and endothelial injuries. A variety of cellular and molecular<br />

mechanisms contribute to the complex pathophysiology of ARDS,<br />

including inflammation-induced coagulation and reduced fibrinolysis,<br />

which favor excessive intra-alveolar fibrin deposition.<br />

„The choice of the right treatment<br />

strategy for polytraumatized patients<br />

has to be based on an individual<br />

risk stratification. The ambition of<br />

contributing to the implementation<br />

of a personalized polytrauma care<br />

encouraged me to establish the<br />

research group ‚Biomarkers‘ in 2011.“<br />

Lukas Negrin<br />

Study:<br />

Negrin LL, Dedeyan M, Plesser<br />

S, Hajdu S. Impact of Polytrauma<br />

and Acute Respiratory<br />

Distress Syndrome on Markers<br />

of Fibrinolysis: A Prospective<br />

Pilot Study. Front Med<br />

(Lausanne). <strong>2020</strong> Jun 2;7:194.<br />

ARDS is a common complication in polytrauma victims, particularly in<br />

those with chest injuries, and a major cause of mortality and morbidity.<br />

Its development is difficult to anticipate, as candidate biomarkers for the<br />

prediction of ARDS were found not to be reliable for clinical use. By assessing<br />

the time-dependent course of the serum antigen levels of the tissue<br />

plasminogen activator (tPA) and the plasminogen activator inhibitor type-1<br />

(PAI-1), which are both thought to reflect endothelial damage, we strived to<br />

identify a cut off value or a clear curve characteristic that might predict the<br />

development of ARDS in polytraumatized patients.<br />

Our prospective study enrolled 28 consecutive blunt polytrauma survivors<br />

(mean age, 38.4 [18-85] years; mean ISS, 35.1 [21-50]), who were directly<br />

admitted to our level I trauma center within one year and transferred to the<br />

ICU after initial treatment fulfilling the inclusion criteria minimum age of 18<br />

years (1), Injury Severity Score (ISS) equal or higher than 16 (2), no anticoagulant<br />

medication before trauma (3), and no treatment with tranexamic acid<br />

(4) to avoid hyperfibrinolysis. To investigate the natural history of biomarker<br />

levels, blood samples for tPA and PAI-1 analysis using Luminex multi-analyte<br />

technology were taken at admission (day 0) and on days 1, 3, 5, 7, 10, 14,<br />

and 21 during hospitalization, as long as the patient consented. Ten healthy<br />

adults, who had responded our call for volunteers, were combined to our<br />

control group. Only one blood sample was taken from them. Mann-Whitney<br />

U-test, Chi-square test, and Wald test were performed to reveal significant<br />

differences (p 3-fold higher than the mean level of the healthy control<br />

group. After decreasing by 36% from day 0 to day 3 (p = 0.004), it basically<br />

remained stable for up to 21 days (included).


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Figure 1: Individual tPA antigen levels<br />

(grey lines) and mean tPA antigen level<br />

(black bold line) in the study group.<br />

Mean ± standard error of the mean<br />

of tPA in healthy controls (green).<br />

tPA is secreted into the plasma primarily by vascular endothelial cells through<br />

two pathways: consecutive secretion, in which proteins are continuously<br />

released as fast as they are synthesized, and regulated secretion, in which<br />

newly synthesized tPA is stored at high concentrations in organelles and<br />

secreted only in response to an appropriate stimulus such as a vascular injury.<br />

We speculate that the physical impact at the time of injury and pathophysiological<br />

processes hereafter might trigger enhanced consecutive secretion,<br />

causing a long-term increase in biomarker levels, whereas regulated secretion<br />

might further raise this „steady-state“ level for a short period in response to<br />

additional endothelial damage.<br />

At day 0 the mean PAI-1 antigen level was 2.6-fold higher than that of healthy<br />

controls. Despite the 20% decrease from day 0 to day 5 (p = 0.007), it remained<br />

elevated for at least three weeks. Mean PAI-1 antigen levels were higher in<br />

poly trauma victims developing pneumonia compared to those not developing<br />

the complication. The Wald test calculated p = 0.128 and 0.044 for the first<br />

week and first three weeks from admission, respectively. Noteworthy, PAI-1<br />

antigen levels increased between day 7 and day 10 in ten of 12 patients sustaining<br />

pneumonia, all ten patients also suffering from ARDS.<br />

A strong positive correlation between tPA and PAI-1 antigen levels within<br />

the first week post-trauma was revealed, indicating that tPA and PAI-1<br />

synthesis and their clearance from circulation by hepatic cells might be biologically<br />

linked. The significant subject correlation over time between each<br />

pair of tPA antigen levels might be explained by a predominant consecutive<br />

secretion, ensuring high continuity in tPA antigen levels. Contrarily, correlation<br />

coefficients between PAI-1 antigen levels were only significant in some


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Figure 2: tPA antigen levels (mean ± standard<br />

error of the mean) in a subgroup of patients with<br />

ARDS (ARDS 1 black bold line) and a subgroup<br />

with no ARDS (ARDS 0, gray bold line). * indicates<br />

significant difference between ARDS 1 and ARDS<br />

0 group. Mean ± standard error of the mean of tPA<br />

in healthy controls (green).<br />

cases, which might be explained by its regulated secretion from platelets<br />

caused by post-trauma triggers, as they vary between individuals.<br />

Priv.-Doz. Dr. Lukas L. Negrin, PhD, MSc<br />

Author:<br />

Lukas Negrin has been working<br />

as a specialist in trauma surgery<br />

at the University Department<br />

for Orthopedics and Trauma<br />

Surgery since 2016. He completed<br />

his habilitation in 2018<br />

and deepened his knowledge<br />

through numerous stays abroad.<br />

His main focus lies on severely<br />

injured and polytraumatized<br />

patients, having already drawn<br />

his interest early on during<br />

his career. Currently he is the<br />

head of the interdisciplinary<br />

working group „Biomarkers in<br />

polytrauma“, the head of the<br />

research cluster „Polytrauma<br />

and traumatic brain injury“, and<br />

deputy head of the task force<br />

„Polytrauma“ of the Austrian<br />

Society for Trauma Surgery.<br />

In our study group 11 patients developed ARDS (mean age, 29.7 [18-48]<br />

years; mean ISS, 35.1 [29-50]), whereas 17 patients (mean age, 44.0 [18-85]<br />

years; mean ISS, 33.7 [21-50] remained unaffected. As displayed in Figure 2,<br />

the mean tPA antigen level was higher in polytraumatized patients developing<br />

ARDS (group ARDS 1) than in those without ARDS (group ARDS 0) for<br />

the entire observation period. A significant difference in tPA antigen levels<br />

was observed at day 1 (p = 0.020), which was confirmed by the Wald test<br />

(p = 0.004 for the period from day 0 to day 7 and p = 0.007 for the period from<br />

day 0 to day 21).<br />

Conclusion<br />

Nevertheless, tPA antigen levels at days 0 and 1 were not suitable to predict<br />

ARDS, as the levels observed at these days presented high variance due to<br />

the different individual injury patterns. Particularly noticeable, however, is<br />

the fact that in each polytrauma victim developing ARDS, the tPA antigen level<br />

steadily increased or suffered a second increase up to the onset of the syndrome,<br />

decreasing immediately thereafter. As each increase in tPA antigen<br />

levels during hospitalization may indicate the imminent development of ARDS,<br />

it should be considered as a warning sign for the timely implementation of<br />

effective therapies that can prevent or at least weaken the manifestation of<br />

the syndrome. Our findings indicate the potential of serum tPA antigen, when<br />

repeatedly assessed, as a reliable biomarker to identify polytraumatized<br />

patients at high risk of developing this syndrome. This approach is not only<br />

cost- and resource-effective, but can also be easily implemented in the clinic<br />

by using bedside tests. If included in the routine of daily blood sampling and<br />

analysis, the assessment of tPA antigen levels would not result in significant<br />

additional work and expenses.


3D Biochips for Research on<br />

Inflammatory Musculoskeletal<br />

Diseases<br />

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In <strong>2020</strong>, a cooperative project of researchers of the „Karl Chiari Lab<br />

for Orthopaedic Biology“, co-coordinated with the „Division of<br />

Rheumatology“, and the CellChipGroup at the Vienna University<br />

of Technology developed a lab-on-a-chip system for analysis<br />

of tissue-level remodeling in arthritic synovium, resulting in<br />

the article entitled „Monitoring Tissue-Level Remodeling during<br />

Inflammatory Arthritis Using a Three-dimensional Synoviumon-a-Chip<br />

with Non-invasive Light Scattering Biosensing“ in RSC<br />

Lab on a Chip (IF: 6.774). The work is a result of years of interdisciplinary<br />

research at the interface of basic biological research<br />

and bioengineering.<br />

Study:<br />

Rothbauer M, Höll G, Eilenberger<br />

C, Kratz SRA, Farooq<br />

B, Schuller P, Olmos Calvo I,<br />

Byrne RA, Meyer B, Niederreiter<br />

B, Küpcü S, Sevelda F,<br />

Holinka J, Hayden O, Tedde<br />

SF, Kiener HP, Ertl P. Monitoring<br />

tissue-level remodelling<br />

during inflammatory arthritis<br />

using a three-dimensional<br />

synovium-on-a-chip with<br />

non-invasive light scattering<br />

biosensing. Lab Chip. <strong>2020</strong><br />

Apr 21;20(8):1461-1471. doi:<br />

10.1039/c9lc01097a<br />

Since 2019, the study of musculoskeletal tissues in microfluidic biochips is<br />

a new additional research focus of tissue engineer Dr. Mario Rothbauer at<br />

the „Karl Chiari Lab for Orthopedic Biology“ (KCLOB) of the Department of<br />

Orthopedics and Trauma Surgery. The biochip team wants to use organotypic<br />

tissue-like microsystems as three-dimensional disease models of the human<br />

joint to recapitulate onset and progression of degradative and inflammatory<br />

processes in arthritic diseases including rheumatoid arthritis (RA) and<br />

osteoarthritis (OA), ranging from molecular pathways up to cellular and<br />

tissue-level architecture and communication.<br />

A systematic in vitro investigation of disease factors and co-factors that<br />

mediate arthritic diseases, using three-dimensional human organotypic<br />

biochips, may be key in identifying basic biological processes that govern<br />

the onset and progression of musculoskeletal diseases. As active member<br />

of the European Society for Alternatives to Animal Experiments (EUSAAT),<br />

Dr. Rothbauer aims at a patient-derived approach for his team’s basic and<br />

applied research, focusing on complimentary or even alternative methods to<br />

animal experiments that include, i.e., the well-established collagen-induced<br />

or collagen-antibody-induced rodent models (CIA/CAIA). The challenging<br />

project idea to establish an animal-product-free synovial organoid biochip<br />

platform for drug screening was awarded in 2019 with the Herbert Stiller<br />

Prize of the Doctors Against Animal Experiments Association. 1<br />

For several years, Dr. Rothbauer has focused on the development of microphysiological<br />

sensor-integrated microsystems (i.e., microvasculature, blood brain<br />

barrier, placenta) 2-4 , with special attention on synovium as inflammatory tissue


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3D Synovium-on-a-chip with scattering biosensing.<br />

„Researchers were able to develop a<br />

non-invasive lab-on-a-chip system for<br />

the modelling of architectural changes<br />

inside RA patient-derived synovial<br />

organoids during inflammatory<br />

remodeling. This constitutes as a<br />

major technological advance as the<br />

study presents the first translation<br />

of human synovium organoids into<br />

a miniaturized biochip format.“<br />

Mario Rothbauer<br />

in arthritic disease modelling. Currently his team is expanding this technological<br />

platform for other musculoskeletal structures, including osteochondral,<br />

adipose, and fibrous tissues. Essentially, patient-derived tissue microsystems<br />

comprise microfluidic microchannels, isolated primary patient cells (i.e.,<br />

fibroblast-like synoviocytes, chondrocytes, fibroblasts, or adipocytes), and<br />

three-dimensional hydrogels as scaffolding material. In contrast to bioprinting,<br />

where the basic shape is defined a priori by the printing technique, the microsystems<br />

of the KCLOB form complex tissue-like structures resembling patient<br />

joint tissues solely by the patient cells’ potential to remodel a bulk scaffold and<br />

organize themselves into functional tissue-like structures.<br />

Development of a Non-invasive Lab-on-a-chip System<br />

Based on almost a decade of collaborative synovium-on-a-chip development,<br />

basic researchers at the „Karl Chiari Lab for Orthopaedic Biology“<br />

and the „Division of Rheumatology“ joined forces with Vienna University of<br />

Technology, the University of Natural Resources and Life Sciences (BOKU),<br />

and the TranslaTUM of Technical University of Munich, to develop a non-invasive<br />

lab-on-a-chip system for the modelling of architectural changes inside<br />

RA patient-derived synovial organoids during inflammatory remodeling. This<br />

constitutes as a major technological advance as the study presents the first<br />

translation of human synovium organoids into a miniaturized biochip format.<br />

It demonstrated the formation of synovial organoids by in situ polymerization of<br />

hydrogel with a high degree of position accuracy as well as a more reproducible<br />

environment for organoid reorganization. Time-resolved light scattering<br />

signals of 3D synovial organoids subjected to a TNF-α-mediated inflammatory<br />

stimulus showed a significant scatter signal increase of 16% and<br />

21% already at day 3 and 4, respectively. These alterations in light scattering<br />

are a direct result of the structural and architectural changes within the<br />

inflamed synovial organoid, featuring Cadherin-11-mediated thickening of<br />

the synovial lining as well as the cellular network structures of the synovial<br />

sublining with a strong Interleukin-6 and Interleukin-8 response.<br />

Further Findings<br />

The basic approach of combining multiple self-organizing biochip organoids<br />

for crosstalk studies is currently under investigation for molecular RA and OA<br />

research. While microfluidic models recapitulating molecular aspects of bone


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45<br />

Chondro-Synovial Crosstalksing.<br />

erosion between bone-derived cells and synoviocytes have been established,<br />

RA’s synovial-chondral axis has not been realized using a microfluidic 3D<br />

model based on human patient cells in vitro. Consequently, our collaborative<br />

team has established a chip-based three-dimensional tissue co-culture model,<br />

simulating the reciprocal crosstalk between individual synovial and chondral<br />

organoids. Preliminary results recently published as BioRxiv preprint 5 already<br />

indicate differential dynamics of organoid formation and remodeling in<br />

co-cultures of chondro-synovial organoids. Particularly, a chondral organoid<br />

in co-culture with synovium showed less condensation and VEGF secretion<br />

in early cultivation phases, where – interestingly –a slightly elevated initial<br />

inflammatory environment has been observed. As proof of principle, the<br />

chondro-synovial biochip was then used to screen the effect of TGF-β3-induced<br />

fibrotic remodeling under low serum conditions, which resulted in<br />

a particularly strong condensation reaction of the synovial organoid, while<br />

interleukin as well as matrix metalloprotease levels were comparable to less<br />

fibrotic conditions. Based on these initial results, the effect of TNFα on the<br />

architecture and soluble crosstalk is currently under investigation to learn more<br />

about the molecular contribution of the chondro-synovial axis in arthritis.<br />

Dr. Mario Rothbauer<br />

Author:<br />

Since 2019, Mario Rothbauer<br />

has been a Post-Doc at the<br />

‚Karl Chiari Lab for Orthopedic<br />

Biology‘. In 2015, he received<br />

his doctorate in biotechnology<br />

from the University of Natural<br />

Resources and Life Sciences<br />

Vienna (BOKU). The main focus<br />

of his research is the bioengineering<br />

of human disease<br />

models using organ- and labon-a-chip<br />

technologies.<br />

References:<br />

1<br />

Herbert Stiller Preis 2019 https://www.aerzte-gegen-tierversuche.de/de/news/aktuellenews/3005-herbert-stiller-foerderpreis-fuer-tierversuchsfreie-forschung-vergeben.<br />

2<br />

Eilenberger, C.; Rothbauer, M.; Selinger, F.; Gerhartl, A.; Jordan, C.; Harasek, M.; Schädl, B.; Grillari, J.;<br />

Weghuber, J.; Neuhaus, W.; Küpcü, S.; Ertl, P. A Microfluidic Multisize Spheroid Array for Multiparametric<br />

Screening of Anticancer Drugs and Blood–Brain Barrier Transport Properties. Adv. Sci. 2021,<br />

n/a (n/a), 2004856. https://doi.org/https://doi.org/10.1002/advs.<strong>2020</strong>04856.<br />

3<br />

Schuller, P.; Rothbauer, M.; Kratz, S. R. A.; Höll, G.; Taus, P.; Schinnerl, M.; Genser, J.; Bastus, N.;<br />

Moriones, O. H.; Puntes, V.; Huppertz, B.; Siwetz, M.; Wanzenböck, H.; Ertl, P. A Lab-on-a-Chip<br />

System with an Embedded Porous Membrane-Based Impedance Biosensor Array for Nanoparticle<br />

Risk Assessment on Placental Bewo Trophoblast Cells. Sensors Actuators B Chem. <strong>2020</strong>, 127946.<br />

https://doi.org/https://doi.org/10.1016/j.snb.<strong>2020</strong>.127946.<br />

4<br />

Rothbauer, M.; Charwat, V.; Bachmann, B.; Sticker, D.; Novak, R.; Wanzenböck, H.; Mathies, R. A.; Ertl, P.<br />

Monitoring Transient Cell-to-Cell Interactions in a Multi-Layered and Multi-Functional Allergy-on-a-<br />

Chip System. Lab Chip 2019, 19 (11), 1916–1921. https://doi.org/10.1039/c9lc00108e.<br />

5<br />

Rothbauer, M.; Byrne, R. A.; Schobesberger, S.; Calvo, I. O.; Fischer, A.; Reihs, E. I.; Spitz, S.; Bachmann,<br />

B.; Sevelda, F.; Holinka, J.; Holnthoner, W.; Redl, H.; Tögel, S.; Windhager, R.; Kiener, H. P.; Ertl, P.<br />

Establishment of a Human Three-Dimensional Chip-Based Chondro-Synovial Co-Culture Joint<br />

Model for Reciprocal Cross-Talk Studies in Arthritis Research. bioRxiv 2021, 2021.02.19.431936.<br />

https://doi.org/10.1101/2021.02.19.431936.


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Biological Regeneration<br />

in Early Osteoarthritis<br />

In <strong>2020</strong>, researchers of the Department of Orthopedics and Trauma<br />

Surgery published an article entitled „Biological Regeneration of<br />

Articular Cartilage in an Early Stage of Compartmentalized Osteoarthritis:<br />

12-Month Results“ in the American Journal of Sports<br />

Medicine 1 . The paper was the result from fruitful interdisciplinary<br />

cooperation between clinical scientists, orthopedic surgeons, and<br />

basic researchers. For her work, Dr. Martina Hauser-Schinhan was<br />

awarded the Research Award of the „Österreichische Gesellschaft<br />

für Orthopädie und Orthopädische Chirurgie (ÖGO)“ which honors<br />

outstanding scientific contributions that have an impact on the<br />

entire field of orthopedics.<br />

Background<br />

Osteoarthritis is the most common joint disease in the western world. It is<br />

characterized by degenerative chondropathy, subchondral bone sclerosis,<br />

and the presence of osteophytes. In contrast to focal cartilage defects,<br />

osteoarthritis affects the entire joint. To date, the curative treatment of<br />

osteoarthritis is limited to joint replacement surgery. However, this entails<br />

certain surgical risks and limited implant survival, especially in young sportive<br />

patients. The demands regarding regeneration, which are also made more<br />

and more by older patients due to their increased activity, can often not be<br />

met with artificial joints. In localized cartilage defects without osteoarthritis,<br />

cartilage regeneration using different methods depending on the size of the<br />

defect has already become clinical reality 2 .<br />

Study:<br />

Schinhan M, Toegel S, Weinmann<br />

D, Schneider E, Chiari C,<br />

Gruber M, Nehrer S, Windhager<br />

R. Biological Regeneration of<br />

Articular Cartilage in an Early<br />

Stage of Compartmentalized<br />

Osteoarthritis: 12-Month<br />

Results. Am J Sports Med.<br />

<strong>2020</strong> May;48(6):1338–1346.<br />

The autologous chondrocyte transplantation technique was already described<br />

in 1994 by Brittberg et al. 3 . A further development of this approach is<br />

MACT (matrix-assisted autologous chondrocyte transplantation), in which<br />

chondrocytes are inserted into the cartilage defect on a carrier matrix. Due<br />

to the poor results of this technique in arthritic joint conditions 4 , the patient<br />

group with early osteoarthritis can only be treated with symptomatic therapy.<br />

Methods<br />

To find a solution for this group of patients, two large animal studies with<br />

follow-up periods of 4 and 12 months, respectively, were carried out as<br />

part of an EU-funded project 1,5 . In total, 48 Austrian mountain sheep were<br />

operated twice. First, unicompartmental osteoarthritis was induced in the<br />

stable joint by removing a standardized cartilage cylinder (7 mm defect with<br />

a loading time of 12 weeks). The removed cartilage was used for the isolation<br />

and cultivation of autologous chondrocytes. In a second procedure, the sheep


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47<br />

Figure 1. (A) Intraoperative picture of the medial<br />

femoral condyle after spongialization. The size of<br />

the defect was standardized to remove the most<br />

degenerated cartilage areas. Macroscopic image<br />

of the (B) MACT group at the 12-month follow-up.<br />

were separated into three different treatment groups (SPONGIO, MATRIX,<br />

MACT) and one control group in which the cartilage defect and the surrounding<br />

tissue were not treated.<br />

In the sheep of the SPONGIO group, the cartilage of the load-bearing zone of<br />

the medial femoral condyle was removed with a standardized oval punch and<br />

a curette. The bone was then removed to a depth of 2.5 mm using a burr with<br />

a spherical and a cylindrical attachment. This technique is called „spongialization“<br />

6 . Bleeding was stopped with a thin layer of fibrin glue (Figure 1A).<br />

„To date, the curative treatment of<br />

osteoarthritis is limited to joint<br />

replacement surgery. However, this<br />

entails certain surgical risks and<br />

limited implant survival, especially<br />

in young sportive patients.“<br />

Stefan Toegel<br />

The animals in the MATRIX group received the same treatment as those in the<br />

SPONGIO group, with the difference that a hyaluronic acid matrix was applied<br />

on top of the fibrin layer. In the MACT group, the procedure was similar to that<br />

in the MATRIX group. The difference was that the hyaluronic acid matrix was<br />

colonized with autologous cultured chondrocytes (1 x 10 6 cells per cm 2 ) before<br />

implantation. The macroscopic evaluation of the cartilage regeneration was<br />

carried out using the Brittberg Score, whereas the histological evaluation was<br />

performed using the Mankin Score and the O’Driscoll Score.<br />

Results<br />

Results of the control group showed a gradual, significant deterioration of<br />

osteoarthritis over 4 and 12 months. There was no regeneration in the defect<br />

area, and the adjacent cartilage showed increasing degeneration both<br />

macroscopically and histologically. In all treatment groups, the regenerated<br />

cartilage showed a zonal structure. After 4 months, the MACT group yielded<br />

significantly better results than the other two regeneration groups (MATRIX,<br />

SPONGIO) regarding macroscopic and histological parameters. The SPONGIO<br />

group showed good chondrocyte quality after 4 months, but the cartilage<br />

surface was very uneven. The MATRIX group was dominated by the formation<br />

of regenerated tissue, which did not correspond to hyaline cartilage.<br />

In the course of 4 to 12 months, an improvement in all regeneration groups<br />

was detected. In 4 out of 6 sheep of the MACT group, the regenerate filled<br />

the full height of the 2.5 mm deep and 20x10 mm large defect (Figure 1B).<br />

Excessive regeneration above the normal cartilage cell height was not<br />

present in any of the animals. Safranin O staining of the regenerated mate-


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48<br />

Figure 2. Histological sections of regenerated<br />

articular cartilage in the MACT group stained with<br />

safranin O at the 12-month follow-up. Shown is<br />

the center of the regenerated area at 2 magnifications.<br />

Blood vessels crossing the tidemark<br />

are marked with arrows, and the chondrocyte<br />

arrangement in the deep zone of cartilage is<br />

presented at a higher magnification. Scale bar:<br />

200 µm (100x), 50 µm (400x).<br />

rial revealed only a slight reduction in staining in MACT and SPONGIO groups<br />

compared to healthy cartilage tissue. In contrast, the MATRIX group showed<br />

strongly reduced staining. The tidemark was broken by blood vessels in all regeneration<br />

groups. Chondrocytes arranged in columns in the central defect area<br />

of the MACT group, suggesting the formation of hyaline cartilage (Figure 2).<br />

In summary, the analysis of the histological evaluation of the 12-month<br />

results showed significant superiority of the MACT and SPONGIO groups<br />

compared to the MATRIX group.<br />

Conclusion<br />

Early OA was treated successfully in a large animal model, with the MACT group<br />

showing the best regeneration after 4 months, persisting until 12 months with<br />

even further improvement during this time. The good results of the SPONGIO<br />

group can be attributed to the use of fibrin glue which was used to stop the<br />

bleeding and standardize the model, and which might have also acted as a<br />

matrix for cells. The poor results of the MATRIX group could be explained by the<br />

sealing of the cancellous bone with flat fibrin glue preventing the migration of<br />

stem cells from the bone into the matrix, suggesting implications for clinical<br />

application in terms of matrix fixation. Further studies are needed to assess<br />

whether these results can be directly transferred to the human knee joint.<br />

Assoz. Prof. Priv.-Doz. Mag. Dr. Stefan Toegel<br />

References:<br />

Author:<br />

Stefan Toegel is head of the<br />

„Karl Chiari Lab for Orthopaedic<br />

Biology“. In 2015, he became an<br />

Associate Professor at the Medical<br />

University of Vienna and<br />

obtained his habilitation in Cell<br />

Biology in 2018. The main focus<br />

of his research is on the pathomechanisms<br />

of osteoarthritis.<br />

1 <br />

Schinhan M, Toegel S, Weinmann D, et al. Biological regeneration of articular cartilage in an early<br />

stage of compartmentalized osteoarthritis: 12-month results. Am J Sports Med. <strong>2020</strong>;48:1338–46.<br />

2 <br />

Aldrian S, Zak L, Wondrasch B, et al. Clinical and radiological long- term outcomes after matrixinduced<br />

autologous chondrocyte transplantation: a prospective follow-up at a minimum of 10 years.<br />

Am J Sports Med. 2014;42:2680–2688.<br />

3 <br />

Brittberg M, Lindahl A, Nilsson A, et al. Treatment of deep cartilage defects in the knee with autologous<br />

chondrocyte transplantation. N Engl J Med. 1994;331:889–895.<br />

4 <br />

Brix MO, Stelzeneder D, Chiari C, et al. Treatment of full-thickness chondral defects with Hyalograft<br />

C in the knee: long-term results. Am J Sports Med. 2014;42:1426–1432.<br />

5 <br />

Schinhan M, Gruber M, Dorotka R, et al. Matrix-associated autologous chondrocyte transplantation<br />

in a compartmentalized early stage of osteoarthritis. Osteoarthr Cartilage. 2013;21:217–225.<br />

6 <br />

Ficat RP, Ficat C, Gedeon P, et al. Spongialization: a new treatment for diseased patellae.<br />

Clin Orthop Relat Res. 1979;144: 74–83.


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49<br />

Total Hip Arthroplasties<br />

after Chiari Pelvic Osteotomy<br />

Total hip arthroplasty (THA) in untreated developmental dysplasia<br />

of the hip (DDH) poses a challenge on the surgeon, as unusual<br />

anatomy, deficient acetabular bone stock, proximal femoral<br />

malrotation, leg length differences, and soft tissue contractions<br />

need to be considered 1-3 . Studies report higher complication rates<br />

and worse outcomes for THA in patients with DDH compared to<br />

primary osteoarthritis 1, 4 . Controversy exists whether prior pelvic<br />

osteotomies have negative effects on subsequent THA.<br />

Many authors have noted that a successful CPO would facilitate the initial<br />

situation for THA by improving the coverage of the femoral head, thus increasing<br />

the bone stock for implantation and fixation of the acetabular component,<br />

and therefore possibly leading to better clinical results 5-8 . The aim of our study<br />

was to carry out a retrospective analysis focusing on the long-term results<br />

of THA after prior CPO and to look at the rate of and reasons for early THA<br />

failures and revision surgery.<br />

Materials and Methods<br />

We screened patient charts and X-rays from all patients who had undergone<br />

a CPO at our department between 1953 and 1986 and invited them to attend<br />

a follow-up examination. Of this consecutive series of 1536 CPOs, follow-up<br />

was completed in 405 patients, with 504 CPOs after a mean time of 36 years<br />

(±8; range, 22-54 years) 9 . The mean age of all patients at CPO was 25.3 years<br />

(±12.8; range, 1.8-55.3). All patients who had already undergone THA (301 hips;<br />

60%) at the time of follow-up examination were included in the study cohort.<br />

Study:<br />

Schneider E, Stamm T, Schinhan<br />

M, Peloschek P, Windhager R,<br />

Chiari C. Total Hip Arthroplasty<br />

after Previous Chiari Pelvic<br />

Osteotomy-A Retrospective<br />

Study of 301 Dysplastic Hips.<br />

J Arthroplasty. <strong>2020</strong><br />

Dec;35(12):3638–3643.<br />

Study Population and Patient Assessment<br />

The study cohort comprised 221 female (90%) and 24 male (10%) patients.<br />

The mean time between CPO and THA was 24.5 years (±10; range,<br />

1 months-45.9). Revision operations were conducted on average 9.6 years<br />

(±6.1; range 4 months-25.4 years) after conversion THA. Patient’s average<br />

age at the time of revision was 57.9 years (±10; range, 33.2-78.5).<br />

Follow up was performed after an average time of 12.7 years (±7.4; range,<br />

2 weeks-36.9 years) after THA.<br />

66 patients (81 THAs) followed our invitation and underwent clinical examination,<br />

179 patients (220 hips) were interviewed on the phone. Information<br />

on former medical history, date and side of THA, peri- and postoperative<br />

complications, and revision surgery was collected and the Harris Hip Score<br />

(HHS) concerning pain and function was completed.


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50<br />

A<br />

B<br />

C<br />

Figure 1: Case: male patient borne 1939;<br />

An arthrodesis of his right hip was performed<br />

in 1956 after seven years of conservative<br />

treatment for tuberculosis. In 1979 his left hip<br />

was treated with a Chiari PO for dysplasia with<br />

subluxation. In 1992 the patient underwent THA<br />

on the right side and in 1995 (16 years after PO)<br />

on the left side. Latest FU 2017 (22 years after<br />

THA): the patient’s satisfaction was good, the<br />

Trendelenburg sign was positive, he showed<br />

almost no pain and good mobility.<br />

(A) Preoperative X-ray<br />

(B) Post PO left (1979)<br />

(C) 1 Year post -PO left (1980)<br />

(D-E) implantation of THA 1995, X-ray<br />

22 years post THA (2017)<br />

D<br />

E<br />

Radiological Evaluation and Results<br />

60 patients with 74 hips attended the radiological follow up. We compiled the<br />

inclination angle of the acetabular cup, signs of radiolucency, ossifications,<br />

and the presence of acetabular roof plasty. The overall survival (OS) of the THA<br />

after 8-, 10-, 20- and 25 years was 95%, 93%, 76% and 68%, respectively.<br />

„This retrospective study supports the<br />

hypothesis that prior CPO does not compromise<br />

the prerequisites for successful<br />

conversion THA at a later stage.“<br />

Eleonora Schneider<br />

12% (N=37) of all patients underwent a revision THA procedure after an<br />

average time period of 9.6 years (±6.1; range 4 months-25.4). Four patients<br />

(11% of all revisions) underwent revision surgery within two years after THA.<br />

Two patients had the acetabular component revised (50% of the early revision),<br />

one for aseptic loosening after four months, the other for breakage of the acetabular<br />

component after nine months. One patient had a total revision (25%)<br />

for aseptic loosening and shaft fracture after 23.9 months. One patient underwent<br />

revision surgery at another hospital due to unknown reasons (25%)<br />

after twelve months. Of the remaining 33 patients one third needed revision<br />

of the acetabular component (N = 11, 33%). Reasons for acetabular revision<br />

surgery were twice aseptic loosening, one dislocation of the component and<br />

once wear. In seven cases the patient could not specify the reason. Total revisions<br />

were performed in nine patients (27%; 3 aseptic loosening, 1 infection,<br />

1 luxation, 3 unknown). Seven hips (21%) had the head and inlay revised, the<br />

reason being excessive wear in five of them, and no identifiable reason in the<br />

other two. Three femoral stems had to be revised for unknown reasons (9%).<br />

In one patient a Girdlestone surgery was performed due to infection (3%). Two<br />

patients reported on a revision surgery on the phone but could not give any<br />

valid details on reason or extent of the performed procedures (6%).<br />

Neither patient’s age at the time of CPO (p= 0.199) nor the age at the time of<br />

THA (p = 0.210) had significant influence on the incidence of revision surgery.<br />

Out of 245 patients (301 hips), 81 were clinically investigated and nine of<br />

them (11%) reported about early complications: two intraoperative femoral<br />

fractures, two postoperative deep venous thrombosis, and five postoperative


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51<br />

nerve lesions (1 N. femoralis, 1 N. peronaeus, 3 unspecified). The average<br />

acetabular component inclination angle was 42° (±7.3; range 21°-63°).<br />

Twelve hips (16%) showed an acetabular roof plasty, its presence had no<br />

significant influence on the probability of revision surgery (p = 0.3368). Four<br />

hips (5%) showed radiolucent lines around the acetabular component, but<br />

none of them had revision surgery so far. In eight hips (11%) radiolucency<br />

was detected around the stem, two (25%) of them were in the group of patients<br />

who had already undergone revision surgery (one due to loosening of the stem,<br />

the other due to polyethylene wear).<br />

Discussion and Conclusion<br />

We found a revision rate of 12% for THA after CPO at an average follow up of<br />

12.7 years (±7.4; range, 2 weeks-36.9 years). The revision rate of 12% could<br />

be partly owed to the long follow up interval, as complications probably had<br />

time to develop, be detected, and addressed. Secondly, 62% of all conversion<br />

THAs were performed prior to the year 2000 and may have resulted in higher<br />

revision rates as older polyethylene components were used. However, the<br />

revision rate compares to other studies in the literature seems to be at the<br />

lower end.<br />

Regarding the overall survival rate, we found out, that conversion THAs after<br />

CPO (10-year OS 93%) would show a similar 10-year survival rate to primary<br />

THA due to osteoarthritis, as reported in the Swedish (95,8%), US (95.2%)<br />

and Australian (93.5%) registries. We could also show that our 10- and 20-<br />

year survival rates (93% and 76%, respectively) were superior to the ones of<br />

patients younger than 35 years with primary THA for osteoarthritis (87% and<br />

61%, respectively) or untreated DDH (87% and 55%) 10,11 . This retrospective<br />

study supports the hypothesis that prior CPO does not compromise the<br />

prerequisites for successful conversion THA at a later stage.<br />

References:<br />

1<br />

Garvin, K.L., et al., Long-term results of total hip arthroplasty in congenital dislocation and<br />

dysplasia of the hip. A follow-up note. J Bone Joint Surg Am, 1991. 73(9): p. 1348–54.<br />

2<br />

Gill, T.J., J.B. Sledge, and M.E. Muller, Total hip arthroplasty with use of an acetabular reinforcement<br />

ring in patients who have congenital dysplasia of the hip. Results at five to fifteen years.<br />

J Bone Joint Surg Am, 1998. 80(7): p. 969–79.<br />

3<br />

Numair, J., et al., Total hip arthroplasty for congenital dysplasia or dislocation of the hip.<br />

Survivorship analysis and long-term results. J Bone Joint Surg Am, 1997. 79(9): p. 1352–60.<br />

4<br />

Crowe, J.F., V.J. Mani, and C.S. Ranawat, Total hip replacement in congenital dislocation<br />

and dysplasia of the hip. J Bone Joint Surg Am, 1979. 61(1): p. 15–23.<br />

Dr. in Eleonora Schneider<br />

5<br />

Hoffman, D.V., E.H. Simmons, and T.W. Barrington, The results of the Chiari osteotomy.<br />

Clin Orthop Relat Res, 1974(98): p. 162–70.<br />

6<br />

Hogh, J. and M.F. Macnicol, The Chiari pelvic osteotomy. A long-term review of clinical and<br />

Author:<br />

Eleonora Schneider is currently<br />

completing her residency at the<br />

Department of Orthopaedics and<br />

Trauma Surgery at the Medical<br />

University of Vienna. The main<br />

focus of her research lies on<br />

joint preserving techniques (hip<br />

and knee).<br />

radiographic results. J Bone Joint Surg Br, 1987. 69(3): p. 365–73.<br />

7<br />

Lack, W., et al., Chiari pelvic osteotomy for osteoarthritis secondary to hip dysplasia. Indications<br />

and long-term results. J Bone Joint Surg Br, 1991. 73(2): p. 229–34.<br />

8<br />

Ohashi, H., K. Hirohashi, and Y. Yamano, Factors influencing the outcome of Chiari pelvic osteotomy:<br />

a long-term follow-up. J Bone Joint Surg Br, 2000. 82(4): p. 517–25.<br />

9<br />

Chiari C, K.R., Windhager R, , Chiari and Salvage Osteotomy for the Treatment of Symptomatic<br />

Acetabular Dysplasia, in The Adult Hip: Hip Preservation Surgery, B.P. Clohisy JC, Della Valle CJ,<br />

Callaghan JJ, Rosenberg AG, Rubash HE, Editor. 2015, Wolters Kluwer: Philadelphia, PA.<br />

10<br />

Swarup, I., et al., Implant Survival and Patient-Reported Outcomes After Total Hip Arthroplasty in<br />

Young Patients. J Arthroplasty, 2018. 33(9): p. 2893–2898.<br />

11<br />

Swarup, I., et al., Implant survival and patient-reported outcomes after total hip arthroplasty<br />

in young patients with developmental dysplasia of the hip. Hip Int, 2016. 26(4): p. 367–73.


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52<br />

The MOCART 2.0 Knee Score:<br />

Morphological MRI for the<br />

Assessment of Cartilage Repair<br />

„Orthopedic surgeons and radiologists<br />

with a special focus on musculoskeletal<br />

radiology and cartilage repair joint<br />

forces to develop a new and updated<br />

version of the original MOCART score,<br />

which would incorporate the developments<br />

in cartilage repair surgery and<br />

MR imaging alike. This culminated in<br />

the publication of the MOCART 2.0 knee<br />

score and atlas.“<br />

Markus Schreiner<br />

Symptomatic focal cartilage defects in young and active patients<br />

pose a significant challenge to the orthopedic surgeon. Left untreated,<br />

focal cartilage defects may increase in size and ultimately<br />

progress to OA. With an increasing number of different surgical<br />

techniques and scaffolds having become available, the comparison<br />

of clinical outcome between these techniques becomes<br />

increasingly important.<br />

While clinical scores provide information on the overall joint-health and<br />

patient satisfaction, morphological and quantitative MRI may provide<br />

additional information on the status of the repair tissue. The qualitative and<br />

quantitative assessment of cartilage repair tissue has been the focus of the<br />

interdisciplinary research group between the Department for Orthopedics<br />

and Trauma surgery and the High-Field MR Center of the Medical University<br />

of Vienna for some time and lead to the introduction of the MOCART (Magnetic<br />

Resonance Observation of Cartilage Repair Tissue) score.<br />

Study:<br />

Schreiner MM, Raudner M,<br />

Marlovits S, Bohndorf K,<br />

Weber M, Zalaudek M, Röhrich<br />

S, Szomolanyi P, Filardo G,<br />

Windhager R, Trattnig S.<br />

The MOCART (Magnetic Resonance<br />

Observation of Cartilage<br />

Repair Tissue) 2.0 Knee Score<br />

and Atlas. Cartilage. 2019 Aug<br />

17:1947603519865308. doi:<br />

10.1177/1947603519865308.<br />

[Epub ahead of print]<br />

However, since the introduction of the MOCART 2.0 knee score, MRI hardware<br />

as well as MR sequences evolved. Similarly, surgical cartilage repair<br />

techniques were refined, and the MOCART score did not reflect these new<br />

developments. In addition, continuous use of the score for more than a<br />

decade exposed some weaknesses of the scoring system. Hence, orthopedic<br />

surgeons and radiologists with a special focus on musculoskeletal radiology<br />

and cartilage repair joint forces to develop a new and updated version of the<br />

original MOCART score, which would incorporate the developments in cartilage<br />

repair surgery and MR imaging alike. This culminated in the publication<br />

of the MOCART 2.0 knee score and atlas.<br />

Main improvements of the score<br />

The main improvements of the score include the elimination of the assessment<br />

of adhesions, the variable „subchondral lamina“, and the variable<br />

„synovitis“. Regarding the variables that were adapted, the variable „volume<br />

of cartilage defect filling“ now allows for a more precise evaluation of defect<br />

filling in 25% increments. Furthermore, hypertrophic filling of up to 150%<br />

being is now being scored with the same scoring as complete repair, as it has<br />

been previously shown that minor hypertrophy has no detrimental effects<br />

on clinical symptoms or long-term outcome. The variable „integration“<br />

was changed in a way that it now only assesses integration to neighboring


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53<br />

1 Volume fill of cartilage defect Scoring<br />

1 Complete filling OR minor hypertrophv: 100 to 150 % filling of total defect volume 20<br />

2 Major hypertrophy ≥ 150 % (1_2a) OR 75 - 99 % filling of total defect volume (1_2b) 15<br />

3 50 - 74% filling of total defect volume 10<br />

4 25 -49% filling of total defect volume 5<br />

5 < 25% filling of total defect volume (1_5a) OR complete delamination in situ (1_5b) 0<br />

2 Integration into adjacent cartilage<br />

1 Complete integration 15<br />

2 Split-like defect at repair tissue and native cartilage interface ≤ 2mm 10<br />

3 Defect at repair tissue and native cartilage interface > 2mm, but < 50 % of repair tissue length 5<br />

4 Defect at repair tissue and native cartilage interface ≥ 50 % of repair tissue length 0<br />

3 Surface of the repair tissue<br />

1 Surface intact 10<br />

2 Surface irregular < 50 % of repair tissue diameter 5<br />

3 Surface irregular ≥ 50 % of repair tissue diameter 0<br />

4 Structure of the repair tissue<br />

1 Homogeneous 10<br />

2 lnhomogeneous 0<br />

5 Signal intensity of the repair tissue<br />

1 Normal 15<br />

2 Minor abnormal - minor hyperintense (5_2a) OR minor hypointense (5_2b) 10<br />

3 Severely abnormal - almost fluid like (5_3a) OR close to subchondral plate signal (5_3b) 0<br />

6 Bony defect or bony overgrowth<br />

1 No bony defect or bony overgrowth 10<br />

2 Bony defect: depth < thickness of adjacent cartilage (6_2a) OR overgrowth<br />

< 50 % of adjacent cartilage (6_2b) 5<br />

3 Bony defect: depth ≥ thickness of adjacent cartilage (6_2a) OR overgrowth ≥ 50 %<br />

of adjacent cartilage (6_2b) 0<br />

7 Subchondral changes<br />

1 No major subchondral changes 20<br />

2 Minor edema-like marrow signal – maximum diameter < 50 % of repair tissue diameter 5<br />

3 Severe edema-like marrow signal – maximum diameter ≥ 50 % of repair tissue diameter 10<br />

4 Subchondral cyst ≥ 5mm in longest diameter (7_4a) or osteonecrosis-like signal (7_4b) 0<br />

Figure 1: Scoring sheet of the Magnetic Resonance<br />

Observation of Cartilage Repair Tissue (MOCART)<br />

2.0 knee score.<br />

cartilage and not underlying bone. Surface irregularities are now subdivided<br />

with respect to cartilage repair length rather than depth to reduce overlap<br />

with the variable filling of the repair tissue. The variable „structure of the<br />

repair tissue“ was kept unchanged. The variable „signal intensity of the repair<br />

tissue“ was adapted to better reflect the reality of current imaging protocols<br />

in clinical routine. Whereas it used to be common practice to measure both<br />

a dual T2w TSE and a T1 3D GRE fs sequence at the time of the introduction<br />

of the original MOCART score, nowadays most protocols do not contain both<br />

sequences anymore. Hence, the signal intensity of the repair tissue is now<br />

recommended to be assessed on a single PDw TSE sequence. Both hypointense<br />

and hyperintense signal changes can now be scored in one variable.<br />

To acknowledge the recent focus on subchondral bone, assessment of bony<br />

defects and subchondral bone is more prominently featured in the MOCART<br />

2.0 knee score. The introduction of the variable „bony defect or bony overgrowth“<br />

allows for the scoring of bony defects as well as intrachondral<br />

osteophytes, which are commonly observed after microfracture and were not<br />

accounted for in the original MOCART score. Furthermore, the variable „sub-


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54<br />

Figure 2: Sagittal proton-density-weighted turbo spin-echo image without fat saturation (A) and<br />

coronal proton-density-weighted turbo spin-echo image with fat saturation of a 31-year-old<br />

female patient 29 months after MACI of a grade IV cartilage lesion of the medial femoral condyle<br />

of the right knee with an overall MOCART 2.0 knee score of 80 points.<br />

chondral bone“ was changed to the variable „subchondral changes“ and now<br />

incorporates the assessment of the presence of bone-marrow edema-like<br />

marrow signal, which can be further subdivided into minor and severe, as<br />

well as the presence of subchondral cysts and osteonecrosis like signals.<br />

Dr. Markus Schreiner<br />

Author:<br />

Markus Schreiner has been a<br />

resident at the Department of<br />

Orthopedics and Trauma Surgery<br />

at the Medical University<br />

of Vienna since 2016 and is a<br />

member of the biomedical MRimaging<br />

Cluster of orthopedic<br />

disorders. Since 2019 he has<br />

coordinated the scientific collaborations<br />

between the Orthopedic<br />

department and the High<br />

Field MR Centre (Prof. Siegfried<br />

Trattnig) at the Medical University<br />

of Vienna, together with<br />

Sebastian Apprich M.D.<br />

Within the biomedical MRimaging<br />

cluster, his research<br />

focuses on the development<br />

and implementation of MR<br />

imaging techniques used for<br />

qualitative and quantitative assessment<br />

of cartilage, tendons,<br />

and intervertebral discs as well<br />

as clinical projects on cartilage<br />

repair surgery.<br />

Evaluation of the MOCART 2.0<br />

The new MOCART 2.0 knee score was then used by two senior radiologists<br />

and two junior radiologists with little or no previous exposure to musculoskeletal<br />

radiology to assess the MRI examination of 24 patients after MACT. All<br />

MRI imaging studies were performed on 3T MR systems with dedicated knee<br />

coils. The average age of the included 24 patients (11 female, 13 male) was<br />

34.8 ± 10.9 years. The median postoperative follow-up interval was 2.3 years.<br />

Median lesion size was 3.8cm2, ranging from 0.9. to 12cm.<br />

When designing the MOCART 2.0 knee score, special emphasis was put on<br />

reproducibility. To ensure that scorings would be consistent between readers<br />

and therefore studies, an atlas was developed alongside the score, which<br />

contains example images for every possible scoring of the MOCART 2.0. knee<br />

score. To assess whether use of this additional resource would provide any<br />

additional value, the inexperienced readers assessed all imaging studies for<br />

a second time after a four-week interval, with the difference that for the second<br />

reading, access to the atlas of the MOCART 2.0. knee score was granted.<br />

The expert readers demonstrated almost perfect overall intrarater<br />

(ICC=0.88, p


TOP-Studien<br />

The Genetic Landscape<br />

of Axonal Neuropathies:<br />

Focus on MME<br />

55<br />

Study:<br />

Senderek J, Lassuthova P,<br />

Kabzińska D, Abreu L, Baets J,<br />

Beetz C, Braathen GJ, Brenner<br />

D, Dalton J, Dankwa L, Deconinck<br />

T, De Jonghe P, Dräger B,<br />

Eggermann K, Ellis M, Fischer<br />

C, Stojkovic T, Herrmann DN,<br />

Horvath R, Høyer H, Iglseder<br />

S, Kennerson M, Kinslechner<br />

K, Kohler JN, Kurth I, Laing<br />

NG, Lamont PJ, Wolfgang N<br />

L, Ludolph A, Marques W Jr,<br />

Nicholson G, Ong R, Petri<br />

S, Ravenscroft G, Rebelo A,<br />

Ricci G, Rudnik-Schöneborn S,<br />

Schirmacher A, Schlotter-<br />

Weigel B, Schoels L, Schüle R,<br />

Synofzik M, Francou B, Strom<br />

TM, Wagner J, Walk D, Wanschitz<br />

J, Weinmann D, Weishaupt<br />

J, Wiessner M, Windhager<br />

R, Young P, Züchner S,<br />

Toegel S, Seeman P, Kochański<br />

A, Auer-Grumbach M. The<br />

genetic landscape of axonal<br />

neuropathies in the middleaged<br />

and elderly: Focus on<br />

MME. Neurology. <strong>2020</strong> Dec<br />

15;95(24):e3163-e3179<br />

The genetic diversity of Charcot-Marie-Tooth (CMT) syndrome,<br />

a hereditary motor-sensory neuropathy, is still not fully explored.<br />

CMT consists of several subtypes, however, CMT1 (demyelinating<br />

form) and CMT2 (axonal form) are the most common types 1 .<br />

The disease onset of CMT usually starts in childhood, but lateonset<br />

forms have been described 2 . For the latter, rare variants<br />

in MME, encoding the metalloprotease neprilysin, have been<br />

published earlier by our group 3 . Here, this international and interdisciplinary<br />

study reveals new gene variants of CMT2 for midelderly<br />

and individuals older than 65 years, leading to late-onset<br />

manifestations.<br />

To investigate unexplained axonal neuropathies and disease onset in<br />

patients older than 35 years, 230 individuals were included into this study.<br />

From 2012 until 2016 clinical and electrophysiological screenings were<br />

conducted and genetic analyses were performed. For the latter, DNA was<br />

isolated from patient’s blood and samples underwent either whole-exome<br />

sequencing (WES, n = 126) or MME single-gene sequencing (n = 104).<br />

Furthermore, the concentration of neprilysin was measured by ELISA in<br />

patients’ blood.<br />

Genetic Causes Identified by WES<br />

126 DNA samples were screened by WES and for 23 samples rare nonsynonymous<br />

likely pathogenic variants were identified, related to CMT2<br />

or resembling the CMT2 phenotype. The most frequently involved gene<br />

was MME (n = 8), followed by LRSAM1 (n = 3), MPZ (n = 2), TTR (n = 2)<br />

and HMBS, VCP, WARS, AARS, DHTKD1, GARS, HARS and HSPB8 (n = 1,<br />

respectively). Concerning the MME gene, three patients carried rare<br />

biallelic variants consistent with autosomal recessive inheritance, while<br />

five patients carried single heterozygous loss-of-function (frameshift,<br />

nonsense or splice) variants.<br />

Targeted sequencing of the MME gene<br />

104 DNA samples were screened independently for MME variants and<br />

revealed private or rare variants in 14 patients. One individual was consistent<br />

with autosomal recessive inheritance, four patients carried single


TOP-Studien<br />

56<br />

Late-onset gnomAD all gnomAD European HZN GENESIS<br />

neuropathies exomes exomes exomes exomes<br />

Number of 230 123,136 55,860 11,225 3,793<br />

samples (alleles) (460) (246,272) (111,720) (22,500) (7,586)<br />

Loss-of-function 9 (0.01957) 172 (0.0007024) 91 (0.0008187) 15 (0.0000667) 3 (0.0004653)<br />

variants * P = 9.35E-11 P = 4.33E-10 P = 4.82E-10 P = 1.14E-9<br />

Rare missense 14 (0.03043) 1,562 (0.006361) 592 (0.005319) 206 (0.009156) 50 (0.006591)<br />

variants # P = 2.3E-6 P = 3.22E-7 P = 0.00015 P = 0.00001<br />

Rare, serious 13 (0.02826) 926 (0.003771) 414 (0.003720) 131 (0.005822) NA<br />

missense variants † P = 4.78E-9 P = 3.70E-8 P = 6.89E-6<br />

p.Pro15 6Leufs * 14 2 (0.004348) 62 (0.0002525) 33 (0.0002965) 6 (0.0002667) 2 (0.0002036)<br />

P = 0.00652 P = 0.0092 P = 0.01 P = 0.018<br />

p.Tyr347Cys 8 (0.01739) 128 (0.0005202) 117 (0.001049) 41 (0.001822) 10 (0.001318)<br />

P = 2.64E-10 P = 5.88E-8 P = 5.36E-6 P = 2.83E-60<br />

p.Met8Val 26 (0.05652) 4,041 (0.01641) 2,719 (0.02435) 544 (0.02418) NA<br />

P = 8.76E-8 P = 0.0001 P = 0.00025<br />

p.Val345lle 4 (0.008696) 463 (0.001882) 354 (0.003174) 67 (0.002978) NA<br />

P=0.012 P = 0.061 P = 0.054<br />

p.Gly225Ala 0 (0) 393 (0.001635) 230 (0.002126) 78 (0.003467) NA<br />

P = 0.99 P = 0.99 P = 0.99<br />

Table 1: Frequencies of MME variants in cases and control.<br />

Figure 1: Manifestations of MME variants ; adapted from 4<br />

(A) Disease severity of cases with autosomal recessive and assumed autosomal dominant inherited MME variants are<br />

shown as proportional distribution (Scores: mild = 1, very severe = 4).<br />

(B) Boxplots comparing neprilysin levels in EDTA plasma obtained from healthy controls (n = 22), late-onset neuropathy<br />

patients without MME variants (n = 34), serious MME variants (n = 15), and the p.Met8Val low-frequency polymorphism<br />

(n = 9).


TOP-Studien<br />

57<br />

rare heterozygous loss-of-function variants, and nine patients carried rare<br />

heterozygous missense variants.<br />

„For individuals older than 65 years we<br />

observed that MME variants may act as<br />

completely penetrant recessive alleles<br />

but also lead to dominantly inherited<br />

susceptibility to axonal neuropathies.“<br />

Katharina Pichler<br />

In Table 1 frequencies of MME variants of 230 individuals (cases and controls)<br />

with late-onset neuropathies were compared to all exomes of gnomAD,<br />

European descent exomes of gnomAD, the exomes of Helmholtz Zentrum<br />

München or exomes of GENESIS. The comparison to control datasets<br />

revealed that, for instance, heterozygous MME loss-of-function variants<br />

showed a statistically significant enrichment in our screening cohort.<br />

Clinical manifestations of MME variants<br />

Although the disease manifested with advanced age, it showed a progressive<br />

and severe behaviour. Patients complained of neuropathic pain, with muscle<br />

wasting and weakness with sensory deficits in the lower legs. CMAP amplitudes<br />

were usually below the normal range (


TOP-Studien<br />

58<br />

Distal Femur Replacement –<br />

Differences between Oncologic<br />

and Non-Oncologic Conditions<br />

[…] this study is of vital importance since<br />

it is the first one to show the differences<br />

between patients with and without<br />

oncologic conditions undergoing DFR.<br />

Cementation might be a better fixation<br />

method for patients with oncologic<br />

condition […]<br />

Kevin Staats<br />

Study:<br />

Staats K, Vertesich K, Sigmund<br />

IK, Sosa B, Kaider A, Funovics<br />

PT, Windhager R. Does a<br />

Competing Risk Analysis Show<br />

Differences in the Cumulative<br />

Incidence of Revision.<br />

Clin Orthop Relat Res. <strong>2020</strong><br />

May;478(5):1062–1073.<br />

The use of megaprosthetic reconstruction of the extremities<br />

originated from extended bone loss due to wide resection of<br />

bone or soft-tissue tumors. However, due to the growing number<br />

of primary total knee arthroplasty (TKA) and the expanding life<br />

expectancy of patients, information about the outcome of distal<br />

femur replacement (DFR) due to non-oncologic conditions in<br />

revision-TKA (rTKA) is becoming more and more important.<br />

We therefore raised the question, whether differences in patient<br />

population and DFR fixation (cemented or cementless) have an<br />

impact on the outcome after DFR.<br />

In a retrospective cohort study, we analyzed patients undergoing DFR due<br />

to oncologic and non-oncologic indications from 1986 to 2016. We were<br />

able to include 229 patients, in total of which 183 patients underwent DFR<br />

due to oncologic, and 46 patients due to non-oncologic conditions. Patients<br />

undergoing DFR due to oncologic reasons were – as expected – significantly<br />

younger than the cohort with non-oncologic conditions. Cementless fixation<br />

was more often performed in oncologic cases, whereas in the non-oncologic<br />

cohort cementation and cementless fixation were almost equally distributed.<br />

Table 1 displays the basic demographics and differences between<br />

patients with oncologic and non-oncologic reasons undergoing cemented<br />

and cementless DFR. The decision whether patients received cemented or<br />

cementless distal femoral replacements was not based on a strict algorithm.<br />

We strongly believe the indications for cemented or cementless fixation have<br />

not changed dramatically in our institution over time. Usually, cementless<br />

fixation is preferred in young, active patients and in those with primary bone<br />

tumors, whereas cemented fixation is mainly used in older patients with<br />

expected poor bone quality or metastatic bone lesions. However, bone quality<br />

and patient activity level were not assessed for the entire patient cohort.<br />

Regardless of which distal femoral replacement system was used, it always<br />

consisted of a cemented or cementless modular component fitting the metaphyseal<br />

and diaphyseal portion of the distal femur.<br />

Patients and Method<br />

In our study, the 149 patients receiving cementless fixation were younger<br />

(median age 31 years [range 16-55 years]) than the 80 patients with cemented<br />

distal femoral replacement (median age: 54 years [range 27-72 years];


TOP-Studien<br />

59<br />

Figure 1: Example of a Distal Femur Replacement<br />

due to a low comminuted periprosthetic distal<br />

femur fracture.<br />

p = 0.001). The endoprosthetic systems used in this study are a fixed-hinge type<br />

of prosthesis (Howmedica Modular Replacement System, Kiel, Germany)<br />

and, beginning in 1999, a modified rotating-hinge version of the fixed-hinge<br />

type (Global Modular Replacement System, Stryker, Kalamazoo, MI, USA)A.<br />

Instead of using a Kaplan-Meier analysis, we performed a competing risk<br />

analysis (Fine-Gray model) for the evaluation of incidence of revision surgery<br />

after DFR. Since patients with oncologic conditions and patients undergoing<br />

DFR due to rTKA have a higher mortality rate than the general population,<br />

we defined “death” as a competing event for revision surgery. Competing risk<br />

analyses have proven to be more accurate than Kaplan-Meier calculations<br />

in patients with higher mortality rates because life expectancy might be too<br />

short for experiencing a revision surgery.<br />

Results<br />

The median follow-up duration in the overall cohort was 85 months (range<br />

0.1-391 months). Thirty-two percent (58 of 183) of oncologic patients and<br />

48% (22 of 46) of non-oncologic patients underwent cemented distal femoral<br />

replacement, representing 35% of the overall cohort. During the observation<br />

period, 30% of the patients (69 of 229) died after DFR, 64 of whom were in<br />

the oncologic cohort. According to the International Society of Limb Salvage’s<br />

classification system, complications leading to revision surgery during the<br />

observation period (1983 to 2016) were either soft-tissue failure (Type 1) in<br />

24 patients (16 with oncologic disease), aseptic loosening (Type 2) in 35 patients<br />

(30 with oncologic disease), structural failure (Type 3) in 19 patients (17 with<br />

oncologic disease), infection (Type 4) in 33 patients (27 with oncologic disease),<br />

or tumor progression (Type 5) in five patients.


TOP-Studien<br />

60<br />

Dr. Kevin Staats<br />

Statistical Analysis<br />

The competing risks analysis revealed cumulative revision incidences of<br />

26% (95% CI, 20.3%-31.9%) at 12 months, 37.9% (95% CI, 31.3%-44.4%)<br />

at 24 months, 52.6% (95% CI, 45.1%-59.5%) at 5 years, and 58.2% (95% CI,<br />

50.1%-65.4%) at 10 years for all patients in this study.<br />

Author:<br />

Kevin Staats started his residency<br />

at the Department of<br />

Orthopedics and Trauma Surgery<br />

at the Medical University<br />

of Vienna in 2016. His research<br />

interests are total joint replacement<br />

and revision arthroplasty<br />

and he is deputy director of the<br />

Arthroplasty Research Cluster.<br />

Dr. Staats was awarded the<br />

Ines Mandl Research Fellowship<br />

and had the opportunity to<br />

expand his clinical and research<br />

focus at the Hospital of Special<br />

Surgery/Weill Cornell University,<br />

New York City. His research on<br />

the antimicrobial effect of electrochemically<br />

modified titanium<br />

surfaces received institutional<br />

funding by CEST Wr. Neustadt<br />

through the FFG-COMET program.<br />

Dr. Staats is currently an<br />

extended board member of the<br />

Austrian Orthopedic Society as<br />

the representative for Austrian<br />

orthopedic residents.<br />

The multivariate analysis adjusted for important variables such as age, sex,<br />

disease (oncologic versus non-oncologic), cementation, and year of surgery<br />

clearly showed that patients with oncologic diagnoses have a lower risk of<br />

undergoing revision surgery than patients with non-oncologic diagnoses (HR<br />

0.44 for oncologic versus non-oncologic; 95% CI, 0.22-0.87; p = 0.02).<br />

Additionally, the multivariate Fine and Gray model yielded an interaction<br />

between the two prognostic factors of oncologic disease and cementation<br />

(p = 0.03), revealing a reduction in the risk of revision with cemented fixation<br />

in patients with oncologic disease (HR 0.53; 95% CI, 0.29-0.98).<br />

According to our results, implant fixation may have a major impact on the<br />

risk of revision surgery in patients with oncologic disease.<br />

Cementation did not have any effect on the cumulative incidence of revision<br />

surgery for any cause in our overall cohort. However, cemented distal femoral<br />

replacements were less frequently revised because of aseptic loosening than<br />

cementless endoprostheses in patients who underwent surgery for oncologic<br />

indications (with an incidence of 6.9% (95% CI, 2.5%-14.3%) at 2 years and<br />

8.6% (95% CI, 3.4%-16.8%) at 5 years, compared with 11.8% (95% CI, 7%-<br />

17.9%) and 19.7% (95% CI, 13.2%-27.1%; p = 0.04), respectively. Due to the<br />

rate of aseptic loosening of cementless implants being almost 12% in the<br />

first two years, we believe that initial implant fixation or osseointegration was<br />

not achieved in patients with oncologic disease.<br />

In conclusion, this study is of vital importance since it is the first one to<br />

show the differences between patients with and without oncologic conditions<br />

undergoing DFR. Cementation might be a better fixation method for<br />

patients with oncologic condition, however further studies are needed to<br />

prove this hypothesis.


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TOP-Studien<br />

62<br />

Biomechanical Evaluation of Intramedullary<br />

Jones Fracture Fixation<br />

Jones fractures or meta-diaphyseal fractures of the proximal fifth<br />

metatarsal (zone II) have a notoriously high rate of nonunion and<br />

delayed union with conservative treatment. Therefore, surgical<br />

fixation using an intramedullary screw is currently recommended<br />

as the primary treatment for active patients, as well as recreational<br />

and professional athletes. Besides early functional mobilization<br />

and a faster return to sports, higher rates of primary fracture<br />

healing have been demonstrated in clinical studies. Nevertheless,<br />

implant choice is a matter of concern since active patients are<br />

prone to failure including nonunion, screw failure, and refracture.<br />

A variety of screw types have been used to treat Jones fractures. Currently,<br />

neither clinical nor biomechanical studies comparing different screws<br />

provide decisive results, so there is no consensus on the ideal screw design<br />

or diameter. Cannulated screws are easy to use and insert but may have a<br />

detrimental biomechanical behavior compared to solid screws. Standard<br />

solid screw insertion can be technically demanding and a prominent screw<br />

head can lead to discomfort and pain at the base of the fifth metatarsal.<br />

A countersinkable or low-profile screw head may reduce this potential<br />

complication, but recent advances in implant design have even developed<br />

fracture-specific screws with combined properties for the treatment of<br />

Jones fractures. To seek clarification in the biomechanical aspects of recent<br />

screw designs regarding the treatment of Jones fractures, this study compares<br />

a solid, fracture-specific screw with a cannulated headless compression<br />

screw in a biomechanical Jones fracture fixation model by simulating initial<br />

postoperative weight-bearing and ultimate loading.<br />

Study:<br />

Willegger M, Benca E, Hirtler L,<br />

Kasparek MF, Bauer G, Zandieh<br />

S, Windhager R, Schuh<br />

R. Evaluation of Two Types of<br />

Intramedullary Jones Fracture<br />

Fixation in a Cyclic and<br />

Ultimate Load Model. J Orthop<br />

Res. <strong>2020</strong> Apr;38(4):911–917.<br />

doi: 10.1002/jor.24530.<br />

Materials and Methods<br />

Ten matched pairs of fresh human foot specimens were used for this biomechanical<br />

study. The specimens were obtained from voluntary donors who<br />

consented to donate their body for research and teaching purposes to the<br />

Center for Anatomy and Cell Biology, Medical University of Vienna during<br />

lifetime. Donor age ranged from 64 to 92 years (mean 78.8 ± 8.7 years). The<br />

specimens were stored at –80°C and thawed at +4°C 48 hours prior to<br />

testing in order to prevent tissue dehydration. After screening for previous<br />

injuries or surgeries at the fifth metatarsal, all specimens proved valid for<br />

inclusion. Bone mineral density (BMD) was assessed prior to biomechanical<br />

testing by use of dual-energy X-ray absorptiometry (DEXA). Scans of the<br />

calcaneus were reported as g/cm 2 . To minimize possible left-right bias, one<br />

foot of each pair was assigned to fracture-specific Jones screw fixation


TOP-Studien<br />

63<br />

Figure 1: Biomechanical test setup: The potted fifth<br />

metatarsal specimen was fixed into a machine vice<br />

on an adjustable platform. A metal rod attached to<br />

the loading frame was used for force transmission<br />

in a plantar to dorsal direction. Light-reflecting<br />

hemispherical markers were glued onto the distal<br />

part of the Jones fracture specimen and onto the<br />

pot and rod for kinematic tracking.<br />

„To seek clarification in the biomechanical<br />

aspects of recent screw<br />

designs regarding the treatment of<br />

Jones fractures, this study compares<br />

a solid, fracture-specific screw with<br />

a cannulated headless compression<br />

screw in a biomechanical Jones<br />

fracture fixation model.“<br />

Madeleine Willegger<br />

(Jones Screw; Arthrex Inc., Naples FL, USA) (JFXS group) and the contralateral<br />

foot was assigned to conventional cannulated headless compression<br />

screw fixation (HCS; DePuySynthes, Solothurn, Switzerland) (HCS group),<br />

with equal numbers of right and left feet in each group. The fifth metatarsals<br />

were further dissected and disarticulated from the feet. Jones fractures at<br />

the meta-diaphyseal junction were created using an oscillating saw. Both<br />

screw types were inserted according to the manufacturer’s instructions. The<br />

intramedullary screw had to „fit and fill“ the medullary canal with the threads<br />

across the fracture site. HCS were available in diameters 4.5-mm and 6.5-<br />

mm, and Jones Screws were used in diameters 4.5-mm and 6.0-mm.<br />

An experimental setup was designed to simulate the postoperative in vivo<br />

loading conditions after surgical Jones fracture treatment. The specimens<br />

of the fifth metatarsal were placed with their proximal aspects in Wood’s<br />

metal in specially fabricated custom-made steel cups, which were fixed<br />

in a machine vice. The biomechanical testing was performed with an 858<br />

Mini Bionix ® (MTS ® Systems Corporation, Eden Prairie, MN). (Figure 1) A<br />

metal rod was used for force transmission onto the plantar aspect of the<br />

metatarsal head. An opto-electronic motion capture system (Smart-E; BTS<br />

Bioengineering, Milan, Italy) with four cameras was used during the loading<br />

process to track kinematic changes. Specimens were loaded with a cyclic<br />

load mean of 12 N at 0.5 Hz for 1000 cycles. The number of load cycles<br />

was chosen based on the loading rate for a physiologically normal lower<br />

limb, which is approximately 5000 cycles per day. One thousand cycles per<br />

day were assumed to realistically simulate post-operative loading during


TOP-Studien<br />

64<br />

Figure 2: Box plots representing the ultimate<br />

load to failure, in Newton, per screw.<br />

The horizontal line indicates the median,<br />

the box extends from the 25th to the 75th<br />

percentile, and the bars indicate the largest<br />

and smallest observed value.<br />

early active rehabilitation. After completion of cyclic loading, an ultimate<br />

load to failure test was performed. Failure was defined as gross failure due<br />

to fracture, screw bending or breakage, or dorsal angulation of the distal<br />

fragment exceeding 10°. Stiffness (slope), displacement, angulation, and<br />

ultimate loads were compared between both groups. Modes of failure were<br />

classified and analyzed with reference to screw type.<br />

Results<br />

There was no significant difference in stiffness and machine displacement<br />

between fifth metatarsals fixed with the solid Jones Fracture-specific<br />

screw (JFXS group) or the cannulated headless compression screw (HCS<br />

group) at any point during the cyclic loading (stiffness:0.324 ≤ p ≤ 0.986;<br />

displacement: 0.131 ≤ p ≤ 0.635). Interfragmentary angulation increased<br />

from 1st to 1000st cycle in both groups, but not statistically significant.<br />

According to preliminary failure criteria, we found a construct survival of<br />

100% in the JFXS group and 90% in the HCS group during cyclic loading.<br />

Priv.-Doz. in Dr. in Madeleine Willegger, FEBOT<br />

Author:<br />

Madeleine Willegger started<br />

her career at the Department<br />

of Orthopaedics at the Medical<br />

University of Vienna in 2014.<br />

She is a specialist in Paediatric<br />

Orthopaedics and Foot and<br />

Ankle Surgery. Dr. Willegger is<br />

Fellow of the European Board<br />

of Orthopaedics and Trauma<br />

Surgery (FEBOT). Her research<br />

activity covers biomechanical<br />

and arthroscopic studies on the<br />

foot and ankle, evaluation of<br />

prognostic factors in soft tissue<br />

sarcoma, and clinical studies on<br />

lower limb rotation in children.<br />

The mean ultimate load to failure was 236.9 ± 107.8 N in the JFXS group<br />

compared with 210.8±150.7 N in the HCS group. Intergroup difference was<br />

not statistically significant (p = 0.429). The most common mode of failure<br />

in HCS constructs was proximal screw head cut out (n = 6, 60%), followed<br />

by loosening of the screw head (n = 3, 30%). In JFXS constructs metatarsal<br />

shaft fracture was the most observed mode of failure (n=4, 40%), followed<br />

by screw head cut out (n = 3, 30%). There was no statistically significant<br />

difference of BMD between the groups. BMD showed a positive correlation<br />

with the pooled ultimate load (R = 0.580, p = 0.007) for all constructs. It<br />

correlated negatively with angulation (angulation at first loading cycle:<br />

R=−0.676, p = 0.003), which was significant for every load cycle among<br />

all tested constructs (angulation at cycle 10: R=−0.552, p=0.002; cycle<br />

100–1,000: p≤0.001).<br />

Conclusion<br />

This biomechanical study shows that both screw constructs (solid fracture-specific<br />

screws versus conventional cannulated headless compression<br />

screws) provide equal ultimate loads and stiffness in a Jones<br />

fracture fixation model. In addition, low BMD seems to be related to a<br />

diminished primary stability and impaired ultimate load in intramedullary<br />

Jones fracture fixation.


TOP-Studien<br />

65<br />

Development of a New<br />

Electronic Navigation System<br />

Development of an electronic navigation system for elimination<br />

of examiner-dependent factors in the ultrasound screening for<br />

developmental dysplasia of the hip in newborns: The presented<br />

paper demonstrates an innovative problem solution to improve<br />

the quality of sonographic hip dysplasia screening, which is<br />

established in the mother-child-pass screening program. It was<br />

developed based on scientific preliminary work at the Medical<br />

University of Vienna.<br />

„Compared to established aids such as<br />

positioning aids for the baby (cradles)<br />

and mechanical transducer guiding<br />

devices, the main advantage of the<br />

presented system is the accurate<br />

detection of the pelvic position.“<br />

Alexander Kolb<br />

Sonography of the infant hip, according to Graf, is the gold standard for early<br />

diagnosis of hip dysplasia 1 . Despite this standardization, examinerdependent<br />

influences on the measurement results have been repeatedly<br />

discussed 2,3 , with tilt of the transducer position in relation to the hip joint<br />

(tilt error) being of importance 4 . In addition to structured training of the<br />

examiners, the aforementioned tilt errors were addressed in particular by<br />

aids such as a positioning aid for the baby (cradle) and a mechanical transducer<br />

guiding device („Sono Guide“ according to Graf). The importance of<br />

these tilt errors was demonstrated using an opto-electronic motion capture<br />

system to capture the transducer position 4 . However, one limitation of the<br />

opto-electronic system is due to its sensor size, making it impossible to capture<br />

the pelvic/hip position of the baby. Thus, analogous to the mechanical<br />

transducer guiding device („Sono Guide“), a defined transducer orientation is<br />

achievable, but the pelvic/hip position remains an uncertainty factor.<br />

Study:<br />

Kolb A, Chiari C, Schreiner M,<br />

Heisinger S, Willegger M, Rettl<br />

G, Windhager R. Development<br />

of an electronic navigation<br />

system for elimination of<br />

examiner-dependent factors<br />

in the ultrasound screening for<br />

developmental dysplasia of<br />

the hip in newborns. Sci Rep.<br />

<strong>2020</strong> Oct 2;10(1):16407.<br />

The aim of this work is the development of a new electronic navigation system,<br />

which is able to detect both pelvic/hip position and transducer position,<br />

and thus contributes to the minimization of examiner-dependent influences<br />

in the sense of relative transducer tilts.<br />

Materials and Methods<br />

A novel electronic navigation system was used to quantify relative tilts<br />

between the pelvis and the transducer (tilt errors) as part of the Graf sonographic<br />

hip dysplasia screening 5,6 : This system consists of two spatial<br />

position sensors, with one sensor fixed to the transducer and the second<br />

sensor epicutaneously attached centrally dorsally over the os sacrum (see<br />

Figure 1). The two sensors are each composed of an accelerometer, a gyroscope<br />

and a magnetometer. Software calculates the relative tilt between the<br />

pelvis and the transducer at three angles (in the frontal, axial, and sagittal<br />

planes) and displays it visually as a navigation aid for the examiner 6 . For<br />

each of the children examined, a sonogram was prepared without the aid of


TOP-Studien<br />

66<br />

Figure 1: Illustration of the position of the<br />

two 3D spatial position sensors: spatial<br />

position sensor epicutaneously centrally<br />

dorsally over the os sacrum for recording<br />

the pelvic position (white arrow (A and B)),<br />

transducer with 3D-printed adapter and<br />

spatial position sensor (white star (A)).<br />

Figure 2: Illustration of the relative tilt<br />

angles between the pelvis/hip joint and the<br />

transducer in the frontal plane (roll) and<br />

axial plane (pitch): (a) transducer alignment<br />

using the navigation system, (b) conventional<br />

alignment of the transducer without<br />

navigation system.<br />

the electronic navigation system (conventional), as well as a sonogram using<br />

the electronic navigation system (navigated), whereby here the transducer<br />

was aligned by the examiner according to the displayed measurement data.<br />

In both sonograms, care was taken to ensure that the sonographic criteria<br />

according to Graf were met.<br />

Results<br />

In total, data from 25 infant hips could be used in 15 consecutive infants;<br />

in five infants, measurement was unilateral due to increasing restlessness.<br />

The tilt angles between the transducer and pelvic sensor of conventional hip<br />

sonography and navigated hip sonography are shown for the frontal plane<br />

(roll angle) and axial plane (pitch angle) in Figure 2 and Table 1.<br />

This test of variance showed significant differences for tilt in the frontal<br />

plane (roll angle, p


TOP-Studien<br />

67<br />

Table 1: Relative roll and pitch angles (between<br />

infant pelvis and transducer in the frontal and<br />

axial planes) for measurements without navigation<br />

(conventional) and for measurements with<br />

navigation system (nav); boldface = significant.<br />

Table 1 min max mean std.-deviation<br />

pitch-angle (conventionel) -23,8° 14,2° 0,6° 9,26<br />

roll-angle (conventionel) -12,5° 14,3° -0,9° 7,68<br />

pitch-angle (nav) -2,8° 4,5° 0,4° 2,23<br />

roll-angle (nav) -3,0° 3,5° 0,3° 2,15<br />

the navigation system significantly reduces the variance of the roll and pitch<br />

angles, i.e. the relative tilt between the infant’s pelvis and the transducer, but<br />

also that the mean value remains unchanged by the alignment with navigation<br />

with regard to these two tilt angles. This means that a more accurate alignment<br />

of the transducer with respect to the pelvis is achieved by the navigation<br />

system, while the target alignment to the original method according to Graf<br />

remains unchanged.<br />

Compared to established aids such as positioning aids for the baby (cradles)<br />

and mechanical transducer guiding devices, the main advantage of the<br />

presented system is the accurate detection of the pelvic position. An additional<br />

strength is not only the accuracy achieved, but also the documentation<br />

of the 3D data, which increases the safety of the method for patients and<br />

examiners.<br />

A limitation of this work is the small size of the collective. Therefore, although<br />

a highly significant improvement in transducer alignment in the frontal and<br />

axial planes could be shown, no significant effect on sonographic alpha<br />

angle could be presented. However, there seems to be a tendency for the<br />

alpha-angles to be reduced under a transducer alignment corresponding to<br />

the navigation data.<br />

Conclusion<br />

This work shows that the alignment between pelvis and transducer can be<br />

significantly improved by the presented navigation system. This represents<br />

a promising approach to increase the quality of the screening program.<br />

Further studies in a large collective are necessary to analyze the effects on<br />

the sonographically measured hip parameters.<br />

Priv.-Doz. Dr. Alexander Kolb<br />

Author:<br />

Alexander Kolb, senior physician,<br />

head of the outpatient clinic<br />

for femoropatellar pathologies<br />

at the Department of Orthopaedics<br />

and Trauma Surgery,<br />

Medical University of Vienna.<br />

Endocert surgeon; 2014 GOTS<br />

fellow. Specialties: Pediatric<br />

orthopedics, endoprosthetics,<br />

sports orthopedics.<br />

References:<br />

1 <br />

Graf, R. Fundamentals of sonographic diagnosis of infant hip dysplasia. J. Pediatr. Orthop. 4,<br />

735–740 (1984).<br />

2 <br />

Ea, S. et al. Inter-observer agreement of ultrasonographic measurement of alpha and beta angles<br />

and the final type classification based on the Graf method. 671–678<br />

3 <br />

Roposch, A., Graf, R. & Wright, J. G. Determining the reliability of the Graf classification for hip<br />

dysplasia. Clin. Orthop. Relat. Res. 447, 119–24 (2006).<br />

4 <br />

Kolb, A. et al. Measurement considerations on examiner-dependent factors in the ultrasound<br />

assessment of developmental dysplasia of the hip. Int. Orthop. 41, 1245–1250 (2017).<br />

5 <br />

Kolb, A. et al. Development of an electronic navigation system for elimination of examiner-dependent<br />

factors in the ultrasound screening for developmental dysplasia of the hip in newborns. Sci. Rep. 10,<br />

1–5 (<strong>2020</strong>).<br />

6 <br />

Kolb, A. Electronic Transducer Guiding Device for the Sonographic Screening for Developmental<br />

Dysplasia of the Hip. MUW Technol. Offer. 782.18 (2019). doi:10.1007/s00264-017-3455-9


Publikationen<br />

68<br />

Originalarbeiten <strong>2020</strong><br />

Der Impact Factor ist eine errechnete Zahl, deren Höhe den Einfluss einer wissenschaftlichen<br />

Fachzeitschrift wiedergibt. Er gibt an, wie häufig im Durchschnitt ein in<br />

dieser Zeitschrift veröffentlichter Artikel von anderen wissenschaftlichen Artikeln<br />

pro Jahr zitiert wird. Die ersten 20 Prozent der Zeitschriften des Fachgebietes im<br />

Journal Citation Reports (geordnet nach Höhe des Impact Factors) sind Top-Journale.<br />

Die zwischen 20 und 60 Prozent liegenden Zeitschriften gelten als Standard-Journale.<br />

Folgend sind hier die Top- und Standard-Publikationen des Jahres <strong>2020</strong> angeführt.<br />

Universitätsklinik für<br />

Orthopädie und Unfallchirurgie<br />

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Agibetov A, Seirer B, Dachs TM, Koschutnik M, Dalos D, Rettl<br />

R, Duca F, Schrutka L, Agis H, Kain R, Auer-Grumbach M,<br />

Binder C, Mascherbauer J, Hengstenberg C, Samwald M,<br />

Dorffner G, Bonderman D. Machine Learning Enables Prediction<br />

of Cardiac Amyloidosis by Routine Laboratory Parameters:<br />

A Proof-of-Concept Study. J Clin Med. <strong>2020</strong> May<br />

3;9(5):1334. (5.688)<br />

Acem I, Verhoef C, Rueten-Budde AJ, Grünhagen DJ, van<br />

Houdt WJ, van de Sande MAJ; PERSARC study group:<br />

Aston W, Bonenkamp H, Desar IME, Ferguson PC, Fiocco<br />

M, Gelderblom H, van Ginkel RJ, van der Graaf W, Griffin<br />

AM, Haas RL, van der Hage JA, Hayes AJ, Jeys LM, Keller<br />

J, Laitinen MK, Leithner A, Maretty-Kongstad K, Ozaki T,<br />

Pollock R, van Praag VM, Smith MJ, Smolle MA, Styring E,<br />

Szkandera J, Tanaka K, Tunn P-U, Willegger M, Windhager<br />

R, Wunder JS, Zaikova O. Age-related differences of oncological<br />

outcomes in primary extremity soft tissue sarcoma:<br />

a multistate model including 6260 patients, Eur J Cancer.<br />

<strong>2020</strong> Dec;141:128-136. (7.275)<br />

Andreou D, Ranft A, Gosheger G, Timmermann B, Ladenstein<br />

R, Hartmann W, Bauer S, Baumhoer D, van den Berg<br />

H, Dijkstra PDS, Dürr HR, Gelderblom H, Hardes J, Hjorth L,<br />

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U; GPOH-Euro-EWING99 consortium. Which Factors<br />

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Relat Res. <strong>2020</strong> Feb;478(2):290-302. doi: 10.1097/<br />

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Apprich SR, Schreiner MM, Szomolanyi P, Welsch GH, Koller<br />

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Benca E, Listabarth S, Flock FKJ, Pablik E, Fischer C, Walzer<br />

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Feb 6;9(2):438. (5.688)<br />

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R, Kasparek MF. Clinical outcome of posterior-stabilized<br />

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in patients with preoperative stiffness. Bone Joint J. <strong>2020</strong><br />

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Breuer R, Fiala R, Schrenk N, Tiefenboeck TM. Prospective<br />

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Bumberger A, Koller U, Hofbauer M, Tiefenboeck TM, Hajdu<br />

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A, Nemecek E, Staats K, Schreiner M, Trost C, Kolb<br />

A, Kainberger F, Pehar S, Milosevic M, Martinovic S, Peric M,<br />

Sampath TK, Vukicevic S, Recombinant Human BMP6 Applied<br />

Within Autologous Blood Coagulum Accelerates Bone Healing:<br />

Randomized Controlled Trial in High Tibial Osteotomy Patients.<br />

J Bone Miner Res. <strong>2020</strong> Oct;35(10):1893-1903 (5.854)<br />

Carlson BB, Salzmann SN, Shirahata T, Ortiz Miller C, Carrino<br />

JA, Yang J, Reisener MJ, Sama AA, Cammisa FP, Girardi<br />

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fusion patients. Neurosurg Focus. <strong>2020</strong> Aug;49(2):E5 (3.642)<br />

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MC, Feely S, Athanasiou-Fragkouli A, Haridy NA, Inherited<br />

Neuropathy Consortium*, Isasi R, Khan A, Laurà M, Magri<br />

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Radiol. <strong>2020</strong> Dec;24(6):627-644. doi: 10.1055/s-0040-<br />

1721464. Epub <strong>2020</strong> Dec 11.PMID: 33307581<br />

Nürnberger S, Wiener Editorial, Sylvia Nurnberger is Researcher<br />

of the Month December <strong>2020</strong> Klinische Wochenschrift<br />

<strong>2020</strong>, 132 (23-24), S.: 801<br />

Okano I, Salzmann SN, Ortiz Miller C, Rentenberger C,<br />

Schadler P, Sax OC, Shue J, Sama AA, Cammisa FP, Girardi FP,<br />

Hughes AP. Correlation between Urine N-Terminal Telopeptide<br />

and Fourier Transform Infrared Spectroscopy Parameters: A<br />

Preliminary Study J Osteoporos. <strong>2020</strong> Feb 11;<strong>2020</strong>:5725086.<br />

doi: 10.1155/<strong>2020</strong>/5725086. eCollection <strong>2020</strong><br />

Payr S. Perioperatives Management in der Kindertraumatologie.<br />

Jatros Orthopädie & Traumatologie Rheumatologie<br />

Payr S. Thorakolumbale Frakturen: eine Herausforderung bei<br />

älteren Patienten. Jatros Orthopädie & Traumatologie Rheumatologie<br />

Rentenberger C, Okano I, Salzmann SN, Shirahata T, Reisener<br />

MJ, Shue J, Sama AA, Cammisa FP, Girardi FP, Hughes AP.<br />

Determinants of Postoperative Spinal Height Change among<br />

Adult Spinal Deformity Patients with Long Construct Circumferential<br />

Fusion. Asian Spine J. <strong>2020</strong> Sep 3. doi: 10.31616/<br />

asj.<strong>2020</strong>.0010. Online ahead of print. PMID: 32872760<br />

Rentenberger C, Okano I, Salzmann SN, Winter F, Plais N,<br />

Burkhard MD, Shue J, Sama AA, Cammisa FP, Girardi FP,<br />

Hughes AP. World Neurosurg. Perioperative Risk Factors<br />

for Early Revisions in Stand-Alone Lateral Lumbar Interbody<br />

Fusion. <strong>2020</strong> Feb;134:e657-e663. doi: 10.1016/j.<br />

wneu.2019.10.164. Epub 2019 Nov 4. PMID: 31698117<br />

Richter K, Chiari C. Epiphyseolysis capitis femoris (ECF),<br />

Sports.Orthop. Traumatol. 36. 296-299 (<strong>2020</strong>).<br />

Rothbauer M, Schuller P, Afkhami R, Wanzenboeck HD, Ertl<br />

P, Zirath H. Microfluidic microarray for single-cell analysis.<br />

e & i Elektrotechnik und Informationstechnik volume 137,<br />

pages108–112(<strong>2020</strong>).<br />

Salzmann SN, Okano I, Shue J, Hughes AP. Disabling Pruritus<br />

in a Patient With Cervical Stenosis. J Am Acad Orthop Surg<br />

Glob Res Rev <strong>2020</strong> Mar 9;4(3):e19.00178.<br />

Schwarz-Nemec U, Friedrich KM, Prayer D, Trattnig S,<br />

Schwarz FK, Weber M, Bettelheim D, Grohs JG, Nemec SF.<br />

Lumbar Intervertebral Disc Degeneration as a Common Incidental<br />

Finding in Young Pregnant Women as Observed on<br />

Prenatal Magnetic Resonance Imaging. J Womens Health<br />

(Larchmt). <strong>2020</strong> Jan 14. doi: 10.1089/jwh.2019.7964. [Epub<br />

ahead of print]<br />

Schwarz-Nemec U, Friedrich KM, Arnoldner MA, Schwarz FK,<br />

Weber M, Trattnig S, Grohs JG, Nemec SF. When an incidental<br />

MRI finding becomes a clinical issue: Posterior lumbar subcutaneous<br />

edema in degenerative, inflammatory, and infectious<br />

conditions of the lumbar spine. Wien Klin Wochenschr.<br />

<strong>2020</strong> Jan;132(1-2):27-34. doi: 10.1007/s00508-019-01576-x<br />

Sigmund IK, Windhager R. Management der intraoperativen<br />

Diagnostik bei periprothetischen Gelenksinfektionen. JAT-<br />

ROS, Orthopädie & Traumatologie Rheumatologie 6 / <strong>2020</strong><br />

Simon S, Resch H. Treatment of hypophosphatasia. Wiener<br />

Medizinische Wochenschrift volume 170, pages 112–<br />

115(<strong>2020</strong>)<br />

Staals EL, Sambri A, Campanacci DA, Muratori F, Leithner A,<br />

Gilg MM, Gortzak Y, Van De Sande M, Dierselhuis E, Mascard<br />

E, Windhager R, Funovics P, Schinhan M, Vyrva O, Sys G,<br />

Bolshakov N, Aston W, Gikas P, Schubert T, Jeys L, Abudu A,<br />

Manfrini M, Donati DM. Expandable distal femur megaprosthesis:<br />

A European Musculoskeletal Oncology Society study<br />

on 299 cases. J Surg Oncol. <strong>2020</strong> Jun 7<br />

Starlinger J, Balls-Berry J, Amadio PC. RE: Aliuskevicius M,<br />

Ostgaard SE, Hauge EM, et al. 2019. Influence of ibuprofen<br />

on bone healing after Colles‘ fracture: A randomized controlled<br />

clinical trial. J Orthop Res. <strong>2020</strong> Jun;38(6):1204-<br />

1205. doi: 10.1002/jor.24582. Epub <strong>2020</strong> Jan 9. (2,730)<br />

Toegel S, Benca E, Negrin L, Windhager R. Neustrukturierung<br />

der <strong>Forschung</strong>slandschaft im neuen Fach Orthopädie und<br />

Traumatologie am Beispiel einer Universitätsklinik. Jatros<br />

Orthpädie & Traumatologie, Rheumatologie<br />

Willegger M, Schuh R. Arthroscopically Assisted Tape Augmentation<br />

for Anterior Talofibular Ligament Repair. Arthrosc<br />

Tech. <strong>2020</strong> May 14;9(6):e809-e816. doi: 10.1016/j.<br />

eats.<strong>2020</strong>.02.017. eCollection <strong>2020</strong> Jun.<br />

Willegger M, Schuh R, Trnka HJ. Komplikationen chirurgischer<br />

Eingriffe an den Kleinzehen. FussSprungg (<strong>2020</strong>),<br />

https://doi.org/10.1016/j.fuspru.<strong>2020</strong>.06.002<br />

Willegger M, Schuh R. Komplikationen der Tarsometatarsale<br />

I Arthrodese (modifizierte Lapidus Arthrodese). FussSprungg<br />

(<strong>2020</strong>), https://doi.org/10.1016/j.fuspru.<strong>2020</strong>.08.005<br />

Winter F, Okano I, Salzmann SN, Rentenberger C, Shue J,<br />

Sama AA, Girardi FP, Cammisa FP, Hughes AP. A Novel and<br />

Reproducible Classification of the Vertebral Artery in the<br />

Subaxial Cervical Spine Oper Neurosurg (Hagerstown). <strong>2020</strong><br />

Jun 1;18(6):676-683. doi: 10.1093/ons/opz310.<br />

Windhager R, Hobusch GM. The role of surgery in soft tissue<br />

sarcoma: Can we improve outcome and function towards<br />

sporting activities? March <strong>2020</strong>. memo - Magazine of European<br />

Medical Oncology 13(1)<br />

Wozasek GE: Mythos und Tatsachen der Knochenverlängerung.<br />

Jatros Orthopädie & Traumatologie Rheumatologie<br />

06/<strong>2020</strong><br />

Buchbeiträge<br />

Benca E. Das instabile Sprunggelenk richtig stabilisieren.<br />

In R. Windhager. <strong>Kompendium</strong> <strong>Forschung</strong> & <strong>Klinik</strong> 2019. (S.<br />

22–24). Wien: Unlimited Media<br />

Grohs, Kainberger. Rückenbeschwerden. In Klinisches und


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ritisches Denken. Manual klinischer Symptome, Syndrome<br />

und anderer Anlassfälle inklusive e-Learning-Plattform.<br />

Franz Kainberger, Georgios Karanikas, Gerit Schernthaner,<br />

Thomas Szekeres. ISBN: 978-3-7089-2071-9; 1. Auflage<br />

<strong>2020</strong>; 185-8<br />

Trattnig S, Welsch GH, Röhrich S, Schreiner MM, Zalaudek M,<br />

Magnetic resonance imaging of the ultrastructural composition<br />

of articular cartilage in disease and repair - Articular<br />

Cartilage of the Knee: Health, Disease and Therapy. 1 January<br />

<strong>2020</strong>, Pages 343-369<br />

Rothbauer M, Ertl P. (<strong>2020</strong>) Emerging Biosensor Trends in<br />

Organ-on-a-Chip. In: Advances in Biochemical Engineering/Biotechnology.<br />

Springer, Berlin, Heidelberg. https://doi.<br />

org/10.1007/10_<strong>2020</strong>_129<br />

Diplomarbeiten/Dissertationen<br />

Chiari C, Willegger M: Karin Hebenstreit. Assessment of the<br />

lower limb torsion in rotational MRI of children – A reliability<br />

study<br />

Egkher A: Wendelken Moritz. Entwicklung einer Diagnosestraße<br />

zur Propriozeptionsmessung bei Pathologien der<br />

unteren Extremität – traumatische Epiphysenlösungen des<br />

Hüftkopfes bei Jugendlichen – Spätergebnisse nach Abschluss<br />

des Wachstums. 07.04.<strong>2020</strong><br />

Giurea A: Franz Xaver Feichtinger. Vergleich: Navigationsdaten<br />

und Röntgenanalyse<br />

Giurea A: Richard Koza. Outcome von Knierevisionsprothesen<br />

7 Jahresergebnisse<br />

Gregori M, Aldrian S: Simek Rosemarie. Clinical und radiological<br />

results after conservative and operative treatment of<br />

bony Bankart lesions 24.08.<strong>2020</strong><br />

Gregori M, Aldrian S: Hegenbart Denise. Epidemiologie und<br />

Behandlungsmöglichkeiten bei traumatischer hinterer<br />

Schulterluxation 09.07.<strong>2020</strong><br />

Grohs J: Feuerstein Laurin. Adjacent Segment Degeneration<br />

with Floating Fusions: A Prospective Study <strong>2020</strong><br />

Grohs J: Winkler Sebastian. A long-term evaluation of patient<br />

satisfaction after posterior lumbar interbody fusion: 20-years<br />

follow-up <strong>2020</strong><br />

Haider T, Hajdu S: Seiler und Aspang Jesse. Postoperative<br />

blood loss in patients with femoral neck fractures treated<br />

with hip arthroplasty – Comparison of lateral and supine positioning.<br />

A retrospective data analysis. 05.12.2019<br />

Haider T, Hajdu S: Fornather Christina. Retrospective evaluation<br />

of endoprosthetic treatment in femoral neck fracture<br />

patients with emphasis on perioperative hospitalisation and<br />

complication rates. 07.04.<strong>2020</strong><br />

Halát G: Lichtnecker Bernadette. Verletzungsassoziierte<br />

Charakteristika, Therapiealgorithmen und Komplikationspotential<br />

bei animalischen Bissverletzungen im Erwachsenenalter<br />

– eine retrospektive Datenanalyse.<br />

Halát G: Dissertation: Clinical and biomechanical characteristics<br />

of surgical repair in bony avulsions of the flexor digitorum<br />

profundus tendon and introduction of an innovative<br />

repair technique<br />

Hofbauer M, Tiefenböck T: Gruber Samuel. Operative Behandlung<br />

der symptomatischen anterioren glenohumeralen<br />

Instabilität mittels Labral-Bridge-Technique – eine Single<br />

Center Analyse. 03.06.<strong>2020</strong><br />

Lass R, Rentenberger C: Daniel Birgsteiner. Navigierte Hüftendoprothetik<br />

– Verlaufsbeobachtung einer prospektiv randomisierten<br />

Kontrollstudie<br />

Lass R, Co-Betreuer: Lukas Rabitsch. 10-Jahres Untersuchung<br />

nach zementfreier Knietotalendoprothese<br />

Maier B, Aldrian S: Hauer Ulrike. Das akute Kompartmentsyndrom<br />

im Kindes- und Jugendalter: Evaluation von Prädiktoren,<br />

Risikofaktoren und Outcome. 04.06.<strong>2020</strong><br />

Negrin L: Moftakhar Timon. Suprakondyläre Humerusfrakturen<br />

bei Kindern – eine retrospektive Datenanalyse.<br />

31.10.2019<br />

Negrin L: Zejnilovic Sara. Erhöht das Vorliegen einer Suizidabsicht<br />

das Sterberisiko bei Polytrauma-Patienten.<br />

10.06.<strong>2020</strong><br />

Negrin L: Masterabschluss Sportmedizin an der Donauuniversität<br />

Krems<br />

Sarahrudi K, Payr S: Plötzl Anna. Retrospektive Analyse<br />

radiologischer Parameter von Wirbelkörperfrakturen des<br />

thorakolumbalen Überganges an der Universitätsklinik für<br />

Orthopädie und Unfallchirurgie, Medizinische Universität<br />

Wien. 30.10.2019<br />

Sarahrudi K, Hingsammer A: Voscak Simon. Clinical Outcome<br />

of Conservative Treatment of Isolated Lateral Clavicular Fractures<br />

- A Retrospective Data Analysis. 21.11.2019<br />

Thalhammer G: Peyman Kheder. Ultraschall-basierte Evaluation<br />

des Musculus pronator quadratus nach beugeseitiger<br />

Verplattung bei distaler Radiusfraktur – Vergleich zweier<br />

operativer Zugänge. 24.10.2019<br />

Thalhammer G: Maria-Theresia Rattasits. Injuries of flexor<br />

tendons in zone 2: a retrospective analysis to compare two<br />

suture materials. 03.12.2019<br />

Thalhammer G: Michaela Pröll. Behandlung von Kahnbeinpseudarthrosen<br />

mittels avaskulärem Knochentransplantat<br />

und Schraube – Retrospektive Evaluation der klinischen und<br />

radiologischen Ergebnisse. 09.01.<strong>2020</strong><br />

Toegel S: Dr. Mahmoud Elshamly. PhD thesis: Intervertebral<br />

disc degeneration: Role of galectins in its pathogenesis and<br />

postoperative complications in its surgical treatment. PhD<br />

defense: 27.11.<strong>2020</strong>.<br />

Waldstein W: Pottmann Christoph.Erstellung von Lernkurven<br />

in der präoperativen Planung der azetabulären Komponente<br />

zur endoprothetischen Versorgung der Coxarthrose.<br />

06.04.<strong>2020</strong><br />

Widhalm H: Huber Felix. Evaluation des klinischen Outcomes<br />

von PatientInnen, die sich eine proximale Humerusfraktur<br />

zugezogen haben – Operation vs. konservative Therapie.<br />

05.12.2019<br />

Zak L, Aldrian S: Vandermuntert Maxime. Vergleich pedobarometrischer<br />

und koordinativer Ergebnisse nach konservativ<br />

oder operativ behandelten Weber B Außenknöchelfrakturen<br />

– eine Pilotstudie zur Untersuchung der kurzfristigen Insta-


Publikationen<br />

78<br />

bilität und Sportfähigkeit – eine exploratorische prospektive<br />

Studie. 06.07.<strong>2020</strong><br />

Preise<br />

Benca E: Stefan-Schuy-Preis der Österreichischen Gesellschaft<br />

für Biomedizinische <strong>Forschung</strong>. QCT-based finite element<br />

prediction of pathologic fractures in proximal femora<br />

with metastatic lesions. November <strong>2020</strong>, online<br />

Böhler C: Arthur Vick Preis (5.000 Euro)<br />

Haider T: AO Trauma Fellowship<br />

Haider T: Open Access Förderung der Österreichischen<br />

Gesellschaft für Unfallchirurgie<br />

Halát G: Grand Rounds Award „Docere cum Laude” Medizinische<br />

Universtiät Wien – Grand Rounds<br />

Humenberger M: Open-Access-Förderpreis der Österreichischen<br />

Gesellschaft für Unfallchirurgie, 1. Platz<br />

Moftakhar T: Emanuel-Trojan-Posterpreis der Österreichischen<br />

Gesellschaft für Unfallchirurgie<br />

Negrin L: Open Access Förderung der Österreichischen<br />

Gesellschaft für Unfallchirurgie<br />

Nia A: Österreichische Gesellschaft für Knochen und Mineralstoffwechsel<br />

(ÖGKM) – Projektpreis 2019/20 für das Projekt:<br />

Bone metabolism, bone microarchitecture, bone marrow<br />

fat composition and vascular calcifications in men with and<br />

without type- 2 diabetes mellitus and fragility fractures<br />

Nürnberger S: Researcher of the Month Dezember <strong>2020</strong> der<br />

MedUni Wien<br />

Rienmüller A.: „Orthopaedic fellow research award best poster<br />

prize <strong>2020</strong>” 28.5.<strong>2020</strong>, University of Toronto, Division of<br />

Orthopaedic Surgery.<br />

Rothbauer M: FFG Innovationsscheck, Stabilität von Oberflächenbeschichtungen<br />

für Zellkultur. Gesamtsumme: 12.500 €<br />

Staats K: 3. Posterpreis Endoprothetikkongress, Berlin<br />

Deutschland, 13.-15.02.<strong>2020</strong>, „Osseointegrative Effekte von<br />

intermittierender Parathormongabe bei initialer Instabilität<br />

von zementfreien Implantaten“<br />

Toegel S (Senior and corresponding author): „Wissenschaftspreis<br />

<strong>2020</strong>” (Science Award) of the Association for<br />

Orthopaedic Research (AFOR) für Daniela Weinmann für die<br />

Publikation „Galectin-8 induces functional disease markers<br />

in human osteoarthritis and cooperates with galectins-1<br />

and -3”.<br />

Toegel S (Senior and corresponding author): „Wissenschaftspreis<br />

<strong>2020</strong>” (Science Award) of the Austrian Spine<br />

Society to Mahmoud Elshamly for publication DOI:10.1002/<br />

jor.24351. Galectins-1 and -3 in Human Intervertebral Disc<br />

Degeneration: Non‐Uniform Distribution Profiles and Activation<br />

of Disease Markers Involving NF-κB by Galectin-1.<br />

Waldstein W: - ‚Reviewer of the Year‘: Archives of Orthopaedic<br />

and Trauma Surgery – Featured Author im Juli <strong>2020</strong> im Journal<br />

‚Bone & Joint Research‘ für die Publikation: Serum cobalt<br />

concentrations remain at low levels at a minimum of 20 years<br />

following metal-on-metal total hip arthroplasty.<br />

Drittmittelfinanzierte Projekte<br />

Projektleitung: Halát G<br />

Vorstellung einer innovativen, Ankerbasierten Rekonstruktionstechnik<br />

in der chirurgischen Therapie der A2-Ringband<br />

Ruptur<br />

Medizinisch-Wissenschaftlicher Fonds des Bürgermeisters<br />

der Bundeshauptstadt Wien - Projektnummer 20029<br />

Zuteilungsdatum: 04.06.<strong>2020</strong><br />

Laufzeit: 6 Monate bis Mai 2021<br />

Gesamtsumme: 1.000 Euro<br />

Projektleitung: Humenberger M<br />

In-vivo Testung einer magnesiumbasierten, intramedullären<br />

Spannosteosynthese im Kaninchenmodell (MgBioISOS)<br />

Förderung der Österreichischen Gesellschaft für Unfallchirurgie<br />

Start: 22.10.2018<br />

Laufzeit: 30 Monate<br />

Projektlaufzeit: 22.10.2018–01.04.2021<br />

Gesamtfördersumme: 17.039,84 Euro<br />

Projektleitung: Maier B<br />

Beurteilung des Heilungsprozesses bei konservativ behandelten<br />

distalen Radiusfrakturen sowie Identifizierung<br />

osteoporotischer Frakturen bei postmenopausalen Frauen<br />

mittels HrPQCT (hochauflösende periphere quantitative<br />

Computertomographie)<br />

Medizinisch-Wissenschaftlicher Fonds des Bürgermeisters<br />

der Bundeshauptstadt Wien – Projektnummer 20043<br />

Zuteilungsdatum: 04.06.<strong>2020</strong><br />

Laufzeit: 18 Monate bis Juni 2022<br />

Gesamtsumme: 2.000 Euro<br />

Projektleitung: Negrin L<br />

Welche Schlussfolgerungen lässt der zeitliche Verlauf von<br />

Biomarkerspiegeln, die im Blut von Polytrauma-Patienten<br />

erhoben werden, zu? – Eine Pilotstudie<br />

Förderung der Österreichischen Gesellschaft für Unfallchirurgie<br />

Start: Jänner 2019<br />

Laufzeit: 48 Monate<br />

Projektlaufzeit: 01.2019–12.2022<br />

Gesamtfördersumme: 10.000 Euro<br />

Projektleitung: Nürnberger S<br />

Cartilage for Cartilage regeneration: Laser engraved decellularized<br />

cartilage as biomaterial for defect treatment<br />

FFG Bridge 1 Projekt<br />

Bewilligung: Juni 2019<br />

Laufzeit: 36 Monate<br />

Projektlaufzeit: 01.10.2019–30.09.2022<br />

Gesamtfördersumme: 317.936 Euro (UCO 40.748 Euro)<br />

Projektleitung: Nürnberger S<br />

Laserbasierte Methode zur Wiederbesiedelung von dezellularisierter<br />

Knorpelmatrix (LaserScaffold) für die Knorpelregeneration<br />

Lorenz Böhler Fonds<br />

Bewilligung: Mai 2019<br />

Projektlaufzeit: 01.09.2019–28.02.2021<br />

Lauzzeit: 18 Monate<br />

Gesamtfördersumme: 33.464 Euro<br />

Projektleitung: Nürnberger S<br />

Biological skin plug system – Characterization of the attachment<br />

cement in ticks


Publikationen<br />

79<br />

Zuteilungsdatum: 28.04.2016<br />

Laufzeit: bis 27.04.2021<br />

Gesamtsumme: 351.254,40 Euro (davon MedUniWien:<br />

196.702 Euro)<br />

Projektleitung: Staats K<br />

Titel: Functionalization of Nanopatterned Titanium (Ti) for<br />

Biomedical Application (FTiBA)<br />

Geldgeber: CEST<br />

Zuteilungsnummer: FA737A1701<br />

Zuteilungsdatum: 15.09.<strong>2020</strong><br />

Laufzeit: 15,5 Monate<br />

Voraussichtliche Fertigstellung: 31.12.2021<br />

Gesamtsumme: 33.696 Euro<br />

Projektleitung: Toegel S.<br />

Titel: Identifizierung von Galektinrezeptoren in arthrotischen<br />

Knorpelzellen<br />

Geldgeber: Johnson&Johnson<br />

Zuteilungsdatum: 01.08.2019<br />

Laufzeit: 18 Monate<br />

Vorraussichtliche Fertigstellung des Projekts: Ende 2021<br />

Gesamtsumme: 75.000 Euro<br />

Projektleitung: Widhalm HK<br />

The Clinical Relevance of micro RNAs in Mild Traumatic<br />

Brain Injury– A Pilot Study<br />

Thema: Micro RNA Diagnostik bei Schädelhirntrauma<br />

Geldgeber: Bürgermeisterfonds der Stadt Wien<br />

Zuteilungsdatum: 01.12.2015<br />

Laufzeit in Monaten: 60 Monate<br />

Voraussichtliche Fertigstellung des Projekts: Ende <strong>2020</strong><br />

Gesamtsummer: 13.000 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Allofit IT with HXPE in Total Hip Arthroplasty<br />

Geldgeber: Zimmer Biomet Austria GmbH<br />

Zuteilungsdatum: 30.05.2012<br />

Laufzeit: 30.05.2012–31.01.2024<br />

Vorraussichtliche Fertigstellung des Projekts: 31.01.2024<br />

Gesamtsumme: 156.800 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Attune Kurz-, mittel- und langfristige Haltbarkeit von<br />

Attune primären Knie-Totalendoprothesen<br />

Geldgeber: DePuy Synthes<br />

Zuteilungsdatum: 15.02.2013<br />

Laufzeit: 15.02.2013–15.12.2029<br />

Vorraussichtliche Fertigstellung des Projekts: 15.12.2029<br />

Gesamtsumme: 52.767 Euro<br />

Projektleitung: Windhager R.<br />

Titel: OSTEOproSPINE<br />

Geldgeber: EU H<strong>2020</strong><br />

Zuteilungsdatum: 01.01.2018<br />

Laufzeit: 01.01.2018–31.12.2022<br />

Vorraussichtliche Fertigstellung des Projekts: 31.12.2022<br />

Gesamtsumme: 740.000 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Educational Grant<br />

Geldgeber: Johnson&Johnson<br />

Zuteilungsdatum: 02.05.2018<br />

Laufzeit: 02.05.2018–31.12.<strong>2020</strong><br />

Vorraussichtliche Fertigstellung des Projekts: 31.12.<strong>2020</strong><br />

Gesamtsumme: 16.500 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Ausbildungsstipendium/Funktionalität des Galektin-<br />

Netzwerks in der arthrotischen Knorpeldegeneration<br />

Geldgeber: Johnson&Johnson<br />

Zuteilungsdatum: 01.07.2018<br />

Laufzeit: 01.07.2018–31.12.<strong>2020</strong><br />

Vorraussichtliche Fertigstellung des Projekts: 31.12.<strong>2020</strong><br />

Gesamtsumme: 30.000 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Lopain-Studie<br />

Geldgeber: MESTEX<br />

Zuteilungsdatum: 27.06.2018<br />

Laufzeit: 27.06.2018–31.12.<strong>2020</strong><br />

Vorraussichtliche Fertigstellung des Projekts: 31.12.<strong>2020</strong><br />

Gesamtsumme: 62.000 Euro<br />

Projektleitung: Windhager R.<br />

Titel: ACTIS<br />

Geldgeber: Johnson&Johnson/DePuyProducts,Inc.<br />

Zuteilungsdatum: 01.12.2010<br />

Laufzeit: 01.12.2010–31.12.2022<br />

Vorraussichtliche Fertigstellung des Projekts: 31.12.2022<br />

Gesamtsumme: 100.000 Euro<br />

Projektleitung: Windhager R.<br />

Titel: Reference Center Agreement<br />

Geldgeber: Medacta<br />

Zuteilungsdatum: 01.06.<strong>2020</strong><br />

Laufzeit: 01.06.<strong>2020</strong>–31.05.2022<br />

Vorraussichtliche Fertigstellung des Projekts: 31.05.2022<br />

Gesamtsumme: 10.000 Euro<br />

Vorsitz bei Tagungen/Wissenschaftliche Leitung<br />

Aldrian S: Vorsitz und Organisation. Novel Cartilage, Bone &<br />

Joint Approaches, Austrian Cluster for Tissue Regeneration<br />

Annual Meeting February 17th – 19th <strong>2020</strong> Österreich<br />

Aldrian S: Vorsitz. Wirbelsäule und Neurologie, 56. Jahrestagung<br />

der Österreichischen Gesellschaft für Unfallchirurgie<br />

(ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie (ÖGOuT),<br />

01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Chiari C: Kursorganisation. Ausbildungskurs der Medizinischen<br />

Universität Wien – Sonografie der Säuglingshüfte<br />

nach Graf – 15.–16.Oktober <strong>2020</strong><br />

Frenzel S: Vorsitz. Workshop des Jungen Forums der ÖGU<br />

– Wirbelsäule – Wesentliche Grundlagen für AssistentInnen,<br />

56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.-03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Frenzel S: Vorsitz. Sitzung des Jungen Forums der ÖGU,<br />

56. Jahrestagung der Österreichischen Gesellschaft für<br />

Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.-03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Grohs J: 21. Symposium der Österr. Ges. für Wirbelsäulenchirurgie.<br />

Die Säulen der Wirbelsäule, Wien 25.01.<strong>2020</strong><br />

Grohs J: Webinar. Die Wirbelsäulenchirurgie in der Corona-<br />

Krise – Degenerative Wirbelsäulenerkrankungen. 07.05.<strong>2020</strong>


Publikationen<br />

80<br />

Humenberger M: Vorsitz. Klausursitzung der Zukunftskommission<br />

der ÖGU, 21.–22.02.<strong>2020</strong> Österreich<br />

Humenberger M: Vorsitz. Grundlagen Schaftfrakturen, 1. ÖGU<br />

& 1. ÖGOuT WEBINAR Versorgung von Schaftfrakturen –Teil 1<br />

29. April <strong>2020</strong> Österreich<br />

Humenberger M: Vorsitz. Versorgung von Schaftfrakturen<br />

–Teil 2, 2. ÖGU & 2. ÖGOuT WEBINAR Versorgung von Schaftfrakturen<br />

–Teil 2 19. Mai <strong>2020</strong> Österreich<br />

Humenberger M: Vorsitz. Becken & Hüfte –Teil 1, 3. ÖGU & 3.<br />

ÖGOuT WEBINAR Becken & Hüfte –Teil 1 19. Juni <strong>2020</strong> Österreich<br />

Humenberger M: Vorsitz. Ellbogen und Unterarm, 69. ÖGU<br />

Fortbildung/5. ÖGU & 5. ÖGOuT Webinar Ellbogen und Unterarm<br />

20.–21. November <strong>2020</strong> Österreich<br />

Humenberger M: Wissenschaftliche Leitung. Grundlagen<br />

Schaftfrakturen, 1. ÖGU & 1. ÖGOuT WEBINAR Versorgung<br />

von Schaftfrakturen – Teil 1 29. April <strong>2020</strong> Österreich<br />

Humenberger M: Wissenschaftliche Leitung. Versorgung<br />

von Schaftfrakturen –Teil 2, 2. ÖGU & 2. ÖGOuT WEBI-<br />

NAR Versorgung von Schaftfrakturen –Teil 2 19. Mai <strong>2020</strong><br />

Österreich<br />

Kdolsky R: Vorsitz. ESTES Webinar „Proximal humerus fractures“,<br />

28 SEP <strong>2020</strong><br />

Kdolsky R: Vorsitz. ESTES Webinar „Geriatric polytrauma –<br />

what is different?”, 23 NOV <strong>2020</strong><br />

Nürnberger S: Vorsitz. Novel Cartilage, Bone & Joint<br />

Approaches, Austrian Cluster for Tissue Regeneration Annual<br />

Meeting February 17th – 19th <strong>2020</strong> Österreich<br />

Nürnberger S: Vorsitz. Cartilage & Joints, Austrian Cluster for<br />

Tissue Regeneration Annual Meeting February 17th – 19th<br />

<strong>2020</strong> Österreich<br />

Pajenda G: Vorsitz. Postervorträge, 56. Jahrestagung der<br />

Österreichischen Gesellschaft für Unfallchirurgie (ÖGU)<br />

und 1. Jahrestagung der Österreichischen Gesellschaft für<br />

Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Sigmund I: Vorsitz: SYMPOSIUM OF ORTHOPEDIC SEPTIC<br />

REVISION 2 (Graz) 25.01.<strong>2020</strong><br />

Sigmund I: Vorsitz: Interactive PJI Webinar, 17.06.<strong>2020</strong> (Austria)<br />

Windhager R: Wissenschaftliche Leitung. Medacta Surgical<br />

Days, 13.–16. Oktober <strong>2020</strong>, Graz<br />

Präsidentschaften und Funktionen bei Journalen<br />

Antoni A: Reviewer Journal of Clinical Medicine<br />

Antoni A: Beratendes Mitglied der ADNANI (Interdisziplinäre<br />

Arbeitsgemeinschaft Neuromedizin)<br />

Antoni A: Kassenprüferin der ÖGU (Österreichische Gesellschaft<br />

für Unfallchirurgie)<br />

Böhler C: Reviewer Bone and Joint Journal<br />

Böhler C: Reviewer Journal of Bone Oncology<br />

Böhler C: Reviewer BMJ Open<br />

Böhler C: Reviewer Rheumatology Oxford Journal<br />

Chiari C: Vizepräsidentin der Österreichischen Gesellschaft<br />

für Orthopädie<br />

Chiari C: Der Orthopäde, Rubrikherausgeberin CME Zertifizierte<br />

Fortbildung<br />

Frenzel S: Reviewer Plos ONE<br />

Gregori M: Reviewer Archives of Orthopaedic and Trauma<br />

Surgery<br />

Giurea A: Guest Editor: Acta Chirurgica Austriaca<br />

Giurea A: Wissenschaftlicher Beirat bei IATROS<br />

Grohs J: Corresponding Member der North American Spine<br />

Society (NASS)<br />

Grohs J: Beirat der Österreichischen Gesellschaft für Wirbelsäulenchirurgie<br />

Grohs J: Preiskommittee Otto Kraupp Preis 24.10.<strong>2020</strong><br />

Grohs J: Reviewer Wiener Klinische Wochenschrift<br />

Grohs J: Reviewer Journal of clinical Medicine<br />

Grohs J: Reviewer British Journal of Neurosurgery<br />

Haider T: Reviewer Injury – International Journal of the Care<br />

of the Injured<br />

Haider T: Reviewer European Journal of Trauma and Emergency<br />

Surgery<br />

Haider T: Reviewer British Medical Journal (BMJ) Open<br />

Holzer S: Präsidiumsmitglied der Österreichische Gesellschaft<br />

für Musik und Medizin (ÖGfMM) Leitung der AG Musikermedizin<br />

<strong>2020</strong>–2022<br />

Humenberger M: Reviewer Injury – International Journal of<br />

the Care of the Injured<br />

Humenberger M: Reviewer Thrombosis and Haemostasis –<br />

International Journal for Vascular Biology and Medicine<br />

Humenberger M: Reviewer PLOS ONE<br />

Humenberger M: Reviewer Journal of Clinical Medicine<br />

Kdolsky R: Section chair ESTES: skeletal trauma and sports<br />

medicine<br />

Lang N: Reviewer Journal of Clinical Medicine<br />

Lang N: Reviewer Scientific Reports<br />

Lang N: Reviewer Diagnostics<br />

Lass R: Editorial Board Austin Journal of Orthopedics &<br />

Rheumatology<br />

Lass R: Editorial Board World Journal of Orthopedics<br />

Lass R: Reviewer Journal of Orthopedic Research<br />

Lass R: Reviewer Bone & Joint Research<br />

Lass R: Reviewer BMC Muskuloskeletal Disorders<br />

Lass R: Reviewer Diagnostic Microbiology<br />

Lass R: Reviewer European Journal of Clinical Microbiology<br />

& Infectious Diseases<br />

Lass R: Reviewer Expert Reviews<br />

Lass R: Reviewer Journal of Functional Biomaterials<br />

Negrin L: Editorial Board Member Journal of Trauma & Treatment<br />

Negrin L: Editorial Board Member Journal of Clinical Trials<br />

Negrin L: Reviewer Bioscience Reports<br />

Negrin L: Reviewer BMC Pulmonary Medicine<br />

Negrin L: Reviewer Journal of Orthopaedic Surgery and Research<br />

Nürnberger S: Reviewer Acta Biomaterialia<br />

Nürnberger S: Reviewer Ticks and Tick born deseases<br />

Pajenda G: Reviewer Archives of Orthopaedic and Trauma<br />

Surgery


Publikationen<br />

81<br />

Payr S: Reviewer Journal of Orthopedic Surgery and Research<br />

Rothbauer M: Editor Organs-on-a-chip<br />

Salzmann S: Reviewer Spine (Phila Pa 1976)<br />

Salzmann S: Reviewer World Neurosurgery<br />

Salzmann S: Reviewer Current Sports Medicine Reports<br />

Salzmann S: Reviewer Osteoporosis International<br />

Staats K: Journal of Arthroplasty<br />

Staats K: Journal of Clinical Medicine<br />

Staats K: Assistent*innenvertreter Österreichische Gesellschaft<br />

für Orthopädie<br />

Starlinger J: Reviewer International Orthopaedics<br />

Starlinger J: Reviewer Scientific Reports<br />

Stelzeneder B: Reviewer European Radiology<br />

Thalhammer G: Reviewer Arthroscopy<br />

Thalhammer G: Reviewer Zeitschrift für Orthopädie und Unfallchirurgie<br />

Tiefenböck T: Reviewer Journal of Orthopedic Surgery and<br />

Research<br />

Tiefenböck T: Reviewer Journal of Clinical Medicine<br />

Tiefenböck T: Reviewer Plos One<br />

Toegel S: Reviewer Biomedicine & Pharmacotherapy<br />

Toegel S: Reviewer Molecular Medicine Reports<br />

Toegel S: Reviewer Cells Tissues Organs, Osteoarthritis and<br />

Cartilage<br />

Toegel S: Reviewer Scientific Reports<br />

Toegel S: Referent für die Österreichische Akademie der<br />

Wissenschaften (OeAW)<br />

Toegel S: Referent Förderprogramm DOC<br />

Toegel S: Gutachter für die Deutsche <strong>Forschung</strong>sgemeinschaft<br />

(DFG)<br />

Toegel S: Gutachter einer Dissertation für die Medizinische<br />

Universität Wien<br />

Toegel S: Gutachter einer Dissertation für die Universität für<br />

Bodenkultur Wien<br />

Waldstein W: Reviewer Archives of Orthopaedic and Trauma<br />

Surgery<br />

Waldstein W: Reviewer Bone and Joint Journal<br />

Widhalm HK: Reviewer Journal of Clinical Medicine<br />

Widhalm HK: Reviewer American Journal of Sportsmedicine<br />

(AJSM)<br />

Widhalm HK: Reviewer Knee Surgery Sports Traumatology<br />

Arthroscopy (KSSTA)<br />

Widhalm HK: Reviewer Neuosurgical Review<br />

Widhalm HK: Reviewer Obesity Surgery<br />

Willegger M: Reviewer International Orthopaedics, BMC<br />

Musculoskeletal Disorders, Journal of Oncology<br />

Willegger M: Generalsekretärin – Österreichische Gesellschaft<br />

für Fußchirurgie<br />

Willegger M: Genderbeauftrage – Österreichische Gesellschaft<br />

für Orthopädie<br />

Windhager R: Mitherausgeber von Journal of Ortopaedic<br />

and Traumatology (SIOT)<br />

Windhager R: Mitherausgeber der Z ORTHOP<br />

Windhager R: Editorial Board Member, Journal of Orthopaedic<br />

Translation<br />

Windhager R: Mitglied des wissenschaftlichen Beirates der<br />

Zeitschrift „Arzt + Patient“<br />

Windhager R: Reviewer Acta Orthopedica<br />

Windhager R: Reviewer British Journal of Surgery<br />

Windhager R: Reviewer Clinical Orthopaedics and Related<br />

Research<br />

Windhager R: Reviewer Der Orthopäde<br />

Windhager R: Reviewer EFORT Open Reviews<br />

Windhager R: Reviewer Journal of Orthopaedic Translation<br />

Windhager R: Reviewer Journal of Clinical Medicine<br />

Windhager R: Reviewer Vorstandsmitglied ÖGO<br />

Windhager R: Mitglied des Wissenschaftlichen Komitees<br />

der ÖGO<br />

Windhager R: Korrespondierendes Mitglied der Deutschen<br />

Gesellschaft für Orthopädie und orthopädische Chirurgie<br />

(DGOOC) ab Oktober 2016<br />

Windhager R: Mitglied der AE-Akademie (Arbeitsgemeinschaft<br />

Endoprothetik) ab 06.12.2013<br />

Windhager R: Mitglied des Vereins zur Förderung von Wissenschaft<br />

und <strong>Forschung</strong> in den neuen Universitätskliniken<br />

am Allgemeines Krankenhaus der Stadt Wien<br />

Windhager R: Mitglied des Advisory Board, Comprehensive<br />

Cancer Center, Graz ab Juli 2014<br />

Windhager R: Mitglied der MedUni Ethikkommission ab<br />

01.03.2010<br />

Windhager R: Ordentliches Mitglied der Europäischen Akademie<br />

der Wissenschaften und Künste März, 2013<br />

Windhager R: Ehrenmitglied: Italienische Gesellschaft für<br />

Orthopädie und Traumatologie (SIOT)<br />

Windhager R: Ehrendmitglied: Böhmischen Gesellschaft für<br />

Orthopädie und Traumatologie<br />

Wozasek GE: Reviewer Injury – International Journal of the<br />

Care of the Injured<br />

Wozasek GE: Fachgruppenobmann der Fachgruppe Unfallchirurgie<br />

Wien<br />

Besuchte Kurse und Kongresse<br />

Aldrian S: ÖGU-Arbeitskreis Knie, 10.1.<strong>2020</strong>, AUVA, Wien<br />

Aldrian S: Austrian Cluster for Tissue Regeneration Annual<br />

Meeting February 17.2.–19.2.<strong>2020</strong>, Wien<br />

Aldrian S: Austrian Knee Symposium 6.3.<strong>2020</strong> Graz<br />

Aldrian S: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der<br />

Österreichischen Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Antoni A: AO Spine Principles Seminar – Intraoperative Imaging,<br />

14. Februar <strong>2020</strong>, Lille, Frankreich<br />

Antoni A: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der<br />

Österreichischen Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.-03.10.<strong>2020</strong>, Salzburg, Österreich<br />

(online)<br />

Antoni A: Deutscher Wirbelsäulenkongress/15. Jahrestagung<br />

der Deutschen Wirbelsäulengesellschaft 09.12.<strong>2020</strong>–<br />

11.12.<strong>2020</strong> (online)<br />

Böhler C: 13. Endoprothetik Kongress Berlin. 13.02.<strong>2020</strong>–<br />

15.02.<strong>2020</strong><br />

Chiari C: Bernese Hip Symposium <strong>2020</strong> – 27.–29. Februar<br />

<strong>2020</strong>, Bern, Schweiz<br />

Chiari C: AGA-Jahreskongress-Online, 16.–19.9.<strong>2020</strong><br />

Chiari C: Virtual EFORT Congress 28.-30. October <strong>2020</strong> (online)


Publikationen<br />

82<br />

Döring K: 56. ÖGU Jahrestagung der ÖGU & 1. Jahrestagung<br />

der ÖGOuT „Wirbelsäule“ – ONLINE. 1.–3.10.<strong>2020</strong><br />

Frenzel S: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich (online)<br />

Frenzel S: AO Trauma Online Masters Course–Fragility<br />

Fractures December 03.–04.12.<strong>2020</strong>, Davos, Switzerland<br />

Grohs J: 21. Symposium der Österr. Ges. für Wirbelsäulenchirurgie,<br />

Wien 25.1.<strong>2020</strong><br />

Halát G: Grund- und Spezielle Ausbildung zum Strahlenschutzbeauftragten.<br />

Nuclear Engineering Seibersdorf, Österreichisches<br />

<strong>Forschung</strong>szentrum Juni <strong>2020</strong><br />

Halát G: ITS Kurs „Becken und proximaler Humerus“ Anatomisches<br />

Institut, Graz<br />

03.09.<strong>2020</strong>–04.09.<strong>2020</strong><br />

Humenberger M: Frenzel S: 56. Jahrestagung der Österreichischen<br />

Gesellschaft für Unfallchirurgie (ÖGU) und 1. Jahrestagung<br />

der Österreichischen Gesellschaft für Orthopädie<br />

und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg,<br />

Österreich (online)<br />

Lang N: AE Masterkurs Knie, München<br />

Lang N: AE Masterkurs Hüfte, München<br />

Negrin L: Swiss Pelvic & Acetabular Course, 17. Jänner <strong>2020</strong>,<br />

Zürich (Schweiz)<br />

Negrin L: Swiss Pelvic & Acetabular Course, 18. Jänner <strong>2020</strong>,<br />

Solothurn (Schweiz)<br />

Negrin L: Internationaler Fortbildungskongress für Sportmedizin,<br />

8.–14. März <strong>2020</strong>, St. Christoph<br />

Negrin L: Notarztrefresher-Kurs (Schockraum + Pädiatrie),<br />

8–9. Juni <strong>2020</strong>, Natters<br />

Negrin L: Zertifikatskurs: Anti-Doping und Dopingprävention<br />

(Basismodul und Spezialmodule), 17–19. September<br />

<strong>2020</strong>, Hall in Tirol<br />

Negrin L: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.-03.10.<strong>2020</strong>, Salzburg, Österreich (online)<br />

Negrin L: ITS Masterclass: Professionell, konstruktiv und<br />

kreativ – Shaping the Future, 22. Oktober <strong>2020</strong>, online<br />

Negrin L: ÖÄK-Zertifikat Antidoping und Dopingprävention<br />

Nürnberger S: Erste Schritte mit Webex (Distant Learning)<br />

Nürnberger S: Der virtuelle Hörsaal mit Webex (Distant Learning)<br />

Nürnberger S: PE-Seminar „Woran erkennt man schlechte<br />

<strong>Forschung</strong>“<br />

Payr S: AE-Masterkurs Hüfte, München, 09.–10.10.<strong>2020</strong><br />

Payr S: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Rentenberger C: 56. Jahrestagung der Österreichischen<br />

Gesellschaft für Unfallchirurgie (ÖGU) und 1. Jahrestagung<br />

der Österreichischen Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Rothbauer M: SELECTBIO Innovations in Microfluidics conference<br />

17–18th August <strong>2020</strong> in Boston MA<br />

Rothbauer M: Annual Conference EUROoCS <strong>2020</strong>, Uppsala,<br />

Sweden, 8–9 July <strong>2020</strong><br />

Schreiner MM: AE-Basis-Kompaktkurs „Hüft- und Knieendoprothetik“<br />

03.–04.09.<strong>2020</strong> Berlin<br />

Sigmund I: OBIC (Webinar) 08.12.<strong>2020</strong> (best paper)<br />

Sigmund I: EBJIS (Webinar) 05.10.<strong>2020</strong> How to build a BIU<br />

Sigmund I: EBJIS (Webinar) 15.12.<strong>2020</strong> Diabetic Foot Infection<br />

Springer B: Wiener Handkurs – Basiskurs, 29.06.–03.07.<strong>2020</strong><br />

Staats K: Endoprothetikkongress <strong>2020</strong>, Berlin, Deutschland,<br />

13.–15.02.<strong>2020</strong><br />

Staats K: Current Concepts in Joint Replacement, (online)<br />

08.–12.12.<strong>2020</strong><br />

Stelzeneder B: 10. Jan. <strong>2020</strong>: Öffentliche Sitzung des Arbeitskreises<br />

Knie der ÖGU<br />

Stelzeneder B: 28. und 29. Feb. <strong>2020</strong>: Leistungsphysiologisch-Internistisch-Pädiatrischer<br />

Grundkurs II, Praxisseminar<br />

(ÖÄK Diplom Sportmedizin), Wien<br />

Stelzeneder B: 29. Feb. und 01. März <strong>2020</strong>: Orthopädisch-Traumatologisch-Pädiatrischer<br />

Grundkurs I (ÖÄK Diplom<br />

Sportmedizin), Wien<br />

Stelzeneder B: 29. April <strong>2020</strong>: 1. ÖGU & 1. ÖGOuT Webinar<br />

„Versorgung von Schaftfrakturen – Teil 1“<br />

Stelzeneder B: 19. Mai <strong>2020</strong>: 2. ÖGU & 2. ÖGOuT Webinar<br />

„Versorgung von Schaftfrakturen – Teil 2“<br />

Stelzeneder B: 19. Juni <strong>2020</strong>: 3. ÖGU & 3. ÖGOuT Webinar<br />

„Becken & Hüfte – Teil 1“<br />

Stelzeneder B: 02. Juli <strong>2020</strong>: 4. ÖGU & 4. ÖGOuT Webinar<br />

„Becken & Hüfte – Teil 2“<br />

Stelzeneder B: 01.–03. Okt. <strong>2020</strong>: 56. ÖGU & 1. ÖGOuT Jahrestagung<br />

<strong>2020</strong>: Wirbelsäule (Online)<br />

Stelzeneder B: 14. Nov. <strong>2020</strong>: Neue Leitlinie Sportkardiologie<br />

der European Society Cardiology (ESC): Aktuelles für Ihre<br />

tägliche Routine. D-A-CH Sportkardiologie (ÖÄK Sportmedizin<br />

Diplom) (online)<br />

Stelzeneder B: 20.+21.Nov. <strong>2020</strong>: 5. ÖGU & 4. ÖGOuT Webinar<br />

„Ellbogen und Unterarm“<br />

Thalhammer G: 1. ÖGU & 1. ÖGOuT Webinar „Versorgung von<br />

Schaftfrakturen – Teil 1“, am 29. April <strong>2020</strong><br />

Thalhammer G: 2. ÖGU & 2. ÖGOuT Webinar „Versorgung von<br />

Schaftfrakturen – Teil 2“, am 19. Mai <strong>2020</strong><br />

Thalhammer G: ISAKOS Webinar, Difficult Elbow Problems:<br />

Heterotopic Ossification and Calcification, held on June 5,<br />

<strong>2020</strong><br />

Thalhammer G: Touching Hands Webinar: Practical Details<br />

that Make Tendon and Nerve Transfer Successful, Saturday,<br />

November 7, <strong>2020</strong><br />

Thalhammer G: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung<br />

der Österreichischen Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Thalhammer G: 4. ÖGU & 4. ÖGOuT Webinar „Becken & Hüfte<br />

– Teil 2“ teilgenommen, am 25. Juni <strong>2020</strong><br />

Thalhammer G: 69. ÖGU Fortbildung / 5. ÖGU & 5. ÖGOuT Webinar<br />

„Ellbogen und Unterarm“, am 20.–21. November <strong>2020</strong><br />

Thalhammer G: AO Webinar – Extra-Articular Distal Radius<br />

Malunion and its Correction<br />

Thalhammer G: AO Webinar – Bail-Out in Complex Distal Radial<br />

Fractures<br />

Thalhammer G: AO Webinar – Distal Radial Fractures - The<br />

Good, the Bad, and the Ugly<br />

Thalhammer G: IWAS WEBINAR, Arthroscopy in Scaphoid


Publikationen<br />

83<br />

fracture, Wrist Arthroscopy in scaphoid non-union, 3D Printing<br />

Assisted Percutaneous Fixation of Scaphoid Fracture<br />

and undisplaced non-union, 11. Dez. <strong>2020</strong><br />

Tiefenböck T: ÖGU-Arbeitskreis Knie, 10.1.<strong>2020</strong>, AUVA, Wien<br />

Tiefenböck T: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Tiefenböck T: GOTS Kongress online, 16.–18. Juni <strong>2020</strong><br />

Tiefenböck T: 37. AGA-Kongress <strong>2020</strong> AGAnywhere – Virtual.<br />

Global.Local 17.–19. September <strong>2020</strong><br />

Weihs V: ASSH <strong>2020</strong> – American Society for Surgery of the<br />

Hand Annual Meeting – San Antonio - ONLINE, October 1,<br />

<strong>2020</strong> - October 3, <strong>2020</strong><br />

Weihs V: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich (online)<br />

Widhalm HK: Konsensusmeeting – „Das Knie- Arbeitskreis<br />

Knie“ der ÖGU: AUVA Wien, 10.01.<strong>2020</strong><br />

Widhalm HK: Zukunftskommissions-Meeting der ÖGU,<br />

AUVA Meidling, 21.–22.02.<strong>2020</strong><br />

Widhalm HK: 1.ÖGU & 1.ÖGOuT Webinar: „Versorgung von<br />

Schaftfrakturen Teil 1“, 29.04.<strong>2020</strong><br />

Widhalm HK: 2.ÖGU & 2.ÖGOuT Webinar: „Versorgung von<br />

Schaftfrakturen Teil 2“, 19.05.<strong>2020</strong><br />

Widhalm HK: 3.ÖGU & 3.ÖGOuT Webinar: „Becken und Hüfte“,<br />

Teil 1“, 19.06.<strong>2020</strong><br />

Widhalm HK: 4.ÖGU & 4.ÖGOuT Webinar: „Becken und Hüfte“,<br />

Teil 2“, 02.07.<strong>2020</strong><br />

Widhalm HK: Virtuelles Jahrestreffen <strong>2020</strong> – DGU – Traumaregister,<br />

11.09.<strong>2020</strong><br />

Widhalm HK: AGA-Jahreskongress-Online, 16.–19.09.<strong>2020</strong><br />

Widhalm HK: 56. Jahrestagung der Österr.Gesellschaft für<br />

Unfallchirurgie,„Wirbelsäule “, Wien-Online, 01.–03.10.<strong>2020</strong><br />

Willegger M: Bernese Hip Symposium Pre-Course <strong>2020</strong> –<br />

26. Februar <strong>2020</strong>, Bern, Schweiz<br />

Willegger M: Workshop Kinderfuß der D.A.F. am 13.11.<strong>2020</strong><br />

in Stuttgart (online)<br />

Willegger M: Bernese Hip Symposium <strong>2020</strong> – 27.–29.Februar<br />

<strong>2020</strong>, Bern, Schweiz<br />

Willegger M: Virtual EFORT Congress 28.–30.October <strong>2020</strong><br />

(online)<br />

Willegger M: AOFAS Annual Meeting <strong>2020</strong> 09.–12. September<br />

– San Antonio, Texas, USA (online)<br />

Willegger M: Kursorganisation: Ausbildungskurs der Medizinischen<br />

Universität Wien – Sonografie der Säuglingshüfte<br />

nach Graf – 15.–16.Oktober <strong>2020</strong><br />

Zak L: ÖGU-Arbeitskreis Knie, 10.1.<strong>2020</strong>, AUVA, Wien<br />

Zak L: Austrian Cluster for Tissue Regeneration Annual<br />

Meeting February 17.2.–19.02.<strong>2020</strong>, Wien<br />

Zak L: 2.ÖGU Web. „Versorgung Schaftfrakturen“, 19.05.<strong>2020</strong><br />

Zak L: Bonesupport Webinar – CeramentG, 28.05.<strong>2020</strong><br />

Zak L: 4. ÖGU Webinar „Becken & Hüfte“, 02.06.<strong>2020</strong><br />

Zak L: Nuvasive Webinar – Bone Transport Nail, 27.08.<strong>2020</strong><br />

Zak L: MSc Sportmedizin - Modul 1, 21.–26.09.<strong>2020</strong><br />

Zak L: EFAS Webinar - Adult Flatfoot, 23.09.<strong>2020</strong><br />

Zak L: GOTS Schweiz Webinar, 24.09.–25.09.<strong>2020</strong><br />

Zak L: 56. Jahrestagung der Österreichischen Gesellschaft<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österreichischen<br />

Gesellschaft für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.-03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Zak L: MSc Sportmedizin – Modul 3, 12.–17.10.<strong>2020</strong><br />

Zak L: NewClip Webinar – Umstellungsosteotomien,<br />

23.10.<strong>2020</strong><br />

Zak L: 69. ÖGU Webinar „Ellbogen und Unterarm“, 21.11.<strong>2020</strong><br />

Zak L: STORZ Webinar „Pre-Xmas Special”, 08.12.<strong>2020</strong><br />

Zak L: MSc Sportmedizin – Modul 3, 18.–23.01.2021<br />

Vorträge<br />

Aldrian S: Eingeladener Vortrag: Möglichkeit bei der Behandlung<br />

von Knorpeldefekten, Austrian Knee Symposium – Orthopädie<br />

und Traumatologie rund um das Kniegelenk Österreich<br />

Benca E: Thermal effects during bone preparation for- and<br />

during insertion of osseointegrated transfemoral implants.<br />

General Assembly of the Austrian Chapter of the European<br />

Society of Biomechanics. November <strong>2020</strong>, online<br />

Chiari C: 29.10.<strong>2020</strong> Eingeladener Vortrag – Women in Orthoedics:<br />

The supported surgeon – How to maximize your potential<br />

Chiari C: 30.10.<strong>2020</strong> Live Interview: Subject: Receive an<br />

EFORT Award and learn from the best! and specifically ‚How<br />

to maximize your chances and how to write your abstract‘. In<br />

the studio with Prof Soren Overgaard.<br />

Döring K, Puchner S, Pastl K, Scarf-Osteotomie und Hallux<br />

valgus nach Austin, ASK THE EXPERT // Webinar Firma Surgebright<br />

– 05. Oktober <strong>2020</strong><br />

Fischer A, Toegel S: The glycobiology of OA: An update. Oral<br />

presentation at the 9th Scientific Meeting of the Ludwig<br />

Boltzmann Institute for Arthritis and Rehabilitation, virtual<br />

meeting. 21.–22. September <strong>2020</strong>.<br />

Frenzel S: Visionen für das Fach Orthopädie und Traumatologie<br />

aus Sicht der AssistentInnenvertreter der ÖGO und ÖGU,<br />

56. Jahrestagung der Österr. Ges. für Unfallchirurgie (ÖGU)<br />

und 1. Jahrestagung der Österr. Ges. für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Frenzel S: Begrüßung, Eröffnung der Sitzung und Überblick<br />

über das vergangene Jahr, 56. Jahrestagung der Österr. Ges.<br />

für Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österr. Ges.<br />

für Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Gregori M: Speichenkopffrakturen, 69. ÖGU Fortbildung/<br />

5. ÖGU & 5. ÖGOuT Webinar Ellbogen und Unterarm, 20.–21.<br />

November <strong>2020</strong>, Österreich<br />

Grohs JG: Wer braucht eine aufrechte Säule? 21. Symposium<br />

der Österr. Ges. für Wirbelsäulenchirurgie, Wien 25.01.<strong>2020</strong><br />

Grohs JG: Webinar: Die Wirbelsäulenchirurgie in der Corona-Krise<br />

– Degenerative Wirbelsäulenerkrankungen.<br />

07.05.<strong>2020</strong><br />

Grohs JG: Belastungsmuster in verschiedenen Sportarten.<br />

ULG Public Health, online 12.05.<strong>2020</strong><br />

Grohs JG: Überlastungsschäden. ULG Public Health, online<br />

12.5.2019<br />

Grohs JG: 21. Symposium der Österr. Ges. für Wirbelsäulenchirurgie,<br />

Die Säulen der Wirbelsäule, Wien 25.01.<strong>2020</strong><br />

Grohs JG: Wirbelsäulenbeschwerden Block21<br />

Grohs JG: Prüfer Returnweek 16.07.<strong>2020</strong><br />

Grohs JG: Planungsteam OSCE <strong>2020</strong><br />

Grohs JG: Planungsteam Block21 <strong>2020</strong><br />

Grohs JG: Planungsteam Block 25 <strong>2020</strong>


Publikationen<br />

84<br />

Grohs JG: Planungsteam TUT3<br />

Grohs JG: Planungsteam TUT2<br />

Grohs JG: Koordinator KPJ <strong>2020</strong><br />

Grohs JG: Gutachter Habilitation Jöstl<br />

Grohs JG: Prüfer PHD Halat<br />

Hajdu S: Eingeladener Vortrag: Welcome, Austrian Cluster<br />

for Tissue Regeneration Annual Meeting February 17th –<br />

19th <strong>2020</strong> Österreich<br />

Holzer S: Thorakale und thorakolumbale Wirbelkörperfrakturen:<br />

die endoskopisch assistierte ventrale und dorsoventrale<br />

Frakturversorgung, 56. Jahrestagung der Österr. Ges. für<br />

Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österr. Ges.<br />

für Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Humenberger M: Tibiakopffrakturen, 1. Online Fortbildung<br />

MUW, 31. März. <strong>2020</strong> Österreich<br />

Humenberger M: Grundlagen der Versorgung von Schaftfrakturen,<br />

1. ÖGU & 1. ÖGOuT WEBINAR Versorgung von<br />

Schaftfrakturen –Teil 1 29. April <strong>2020</strong> Österreich<br />

Humenberger M: Ellenbogenluxationsfrakturen, GOTS Sportarzt<br />

Zertifikatskurs, 31.07.<strong>2020</strong>, Österreich<br />

Humenberger M: Bericht aus der Zukunftskommission, 56.<br />

Jahrestagung der Österr. Ges. für Unfallchirurgie (ÖGU) und<br />

1. Jahrestagung der Österr. Ges. für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Kdolsky R: Eingeladender Vortrag: Komplikationen der Versorgung<br />

von Schaftfrakturen, 2. ÖGU & 2. ÖGOuT WEBINAR Versorgung<br />

von Schaftfrakturen – Teil 2 19. Mai <strong>2020</strong> Österreich<br />

Laggner R: Die Versorgung von Verletzungen am zervikothorakalen<br />

Übergang an einem Level I Traumazentrum – eine<br />

retrospektive Analyse, 56. Jahrestagung der Österr. Ges. für<br />

Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österr. Ges.<br />

für Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Lass R: Senior Mentoring-Programm der MedUniWien im<br />

Studienjahr 2019/<strong>2020</strong><br />

Nürnberger S: CartiScaff, Austrian Cluster for Tissue Regeneration<br />

Annual Meeting February 17th–19th <strong>2020</strong> – Highlights<br />

of Musculoskeletal Research and Imaging Österreich<br />

Pajenda G: Verletzungen der unteren Halswirbelsäule – Diagnostik<br />

und Therapiealgorithmus, 56. Jahrestagung der<br />

Österr. Ges. für Unfallchirurgie (ÖGU) und 1. Jahrestagung<br />

der Österr. Ges. für Orthopädie und Traumatologie (ÖGOuT),<br />

01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Pajenda G: Fallpräsentation: Mein schlimmster Fall, 56.<br />

Jahrestagung der Österr. Ges. für Unfallchirurgie (ÖGU) und<br />

1. Jahrestagung der Österr. Ges. für Orthopädie und Traumatologie<br />

(ÖGOuT), 01.–03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Pajenda G: Eingeladener Vortrag: Trauma und Versorgung<br />

der unteren Halswirbelsäule, Webinar Johnson & Johnson<br />

Institute, 03.07.<strong>2020</strong><br />

Rienmüller A: Functional objective assessment using the<br />

TUG-test is a useful tool to evaluate outcome in lumbar spinal<br />

stenosis. 20th Annual Scientific Conference of the Canadian<br />

Spine Society, Whistler BC, Canada 26.02.–29.02.<strong>2020</strong><br />

Rienmüller A: Gait variability is a valid tool to characterize<br />

severity of degenerative cervical myelopathy: a prospective<br />

clinical study. 20th Annual Scientific Conference of the Canadian<br />

Spine Society, Whistler BC, Canada 26.02.–29.02.<strong>2020</strong><br />

Rothbauer M: Eingeladender Vortrag. SELECTBIO Innovations<br />

in Microfluidics conference 17-18th August <strong>2020</strong> in Boston<br />

MA on ‚Joint-on-a-Chip as Alternative to Animal Models in<br />

Arthritis Research‘<br />

Rothbauer M: Plus Lucis training week for chemistry and<br />

physics teachers (VFPC), Vienna, Austria (<strong>2020</strong>) on „Research<br />

without animal experiments – interdisciplinary research at<br />

the interface between chemistry, physics and biology“<br />

Schwarz G: Quality and Readability of Online Resources<br />

on Chronic Ankle Instability, 37. AGA-Kongress <strong>2020</strong> AG-<br />

Anywhere – Virtual.Global.Local, 17.–19. September <strong>2020</strong><br />

Schweiz, 17.09.<strong>2020</strong><br />

Staats K: Sitzung des Jungen Forums der ÖGU, 56. Jahrestagung<br />

der Österr. Ges. für Unfallchirurgie, 01.–02.10.<strong>2020</strong><br />

Staats K: Vorlesung (Wahlfach): „Grundlagen der Hüft- und<br />

Knieendoprothetik<br />

Starlinger J: Eingeladener Vortrag: Polytraumaversorgung<br />

in Österreich – aktuelle Konzepte und Perspektiven, BÖC<br />

Webinar Österreich<br />

Toegel S: The glycobiology of OA: Status quo and ongoing<br />

research. Oral presentation at the 8th Scientific Meeting of<br />

the Ludwig Boltzmann Institute for Arthritis and Rehabilitation,<br />

Vienna, Austria, 17. June <strong>2020</strong>.<br />

Toegel S: The glyobiology of OA: Recent progress and future<br />

perspectives. Oral presentation at the Scientific Advisory<br />

Board Meeting, Ludwig Boltzmann Institute for Arthritis and<br />

Rehabilitation, Vienna, Austria, 23. November <strong>2020</strong>.<br />

Toegel S: Basic Lecture: Osteoarthritis biology. #850.701, Vo.<br />

Study: N790 Doctoral Programme of Applied Medical Science.<br />

Thematic programme: Regeneration of Bones and Joints.<br />

Toegel S: SSM 3-Projektstudie (Wahlpflichtteil). #808.008,<br />

SK. Study: N202 Human medicine.<br />

Toegel S: Practical Seminar, #850.320, Se. Study: N790 Doctoral<br />

Programme of Applied Medical Science. Thematic programme:<br />

Regeneration of Bones and Joints.<br />

Toegel S: SSM2 - Arthrose: Von der klinischen Wissenschaft<br />

bis zur Grundlagenforschung, # 806.087, Se. Study: N202<br />

Human medicine.<br />

Toegel S: Basic Lecture: Gene expression anaylsis. #850.022,<br />

Vo. Study: N790 Doctoral Programme of Applied Medical Science.<br />

Thematic programme: Regeneration of Bones and Joints.<br />

Weihs V: Eingeladener Vortrag: Stress-induced cardiomyopathy:<br />

clinical and echocardiographic features, treatment and<br />

prognosis, 62nd Annual World Congress – ICA <strong>2020</strong> International<br />

College of Angiology Back to Back Online Meeting – 52.<br />

Jahrestagung ÖGG <strong>2020</strong> Österreichische Gesellschaft für<br />

Gefäßchirurgie Österreich<br />

Widhalm H: Erste Erfahrungen aus Österreich: Einsatz des<br />

Allograft- Transplantates bei der Rekonstruktion des vorderen<br />

Kreuzbandes, 37. AGA-Kongress <strong>2020</strong> AGAnywhere –<br />

Virtual.Global.Local, 17.–19. September <strong>2020</strong>, Schweiz<br />

Willegger M: Excellent Reliability But Significant Difference<br />

Exists Among MRI Measurement Methods For Femoral<br />

Torsion In Paediatric Patients. Virtual EFFORT Congress<br />

28.–30. October <strong>2020</strong> – Paediatric Orthopaedics / Hip<br />

Windhager R: WP1 Phase II clinical trial „Clinical update<br />

and protocol amendments“. Osteoprospine, 2nd Progress<br />

Meeting, 30.–31. Januar <strong>2020</strong>, Zagreb<br />

Windhager R: Lecture: „Resection and Reconstruction of bone


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Publikationen<br />

86<br />

tumors -lessons learnt from the last 3 decades“, 21.02.<strong>2020</strong>,<br />

Catholic University of Rome, Institute of Orthopedics, Rom<br />

Windhager R: Moderation: Medacta Surgical Days, 13.–16.<br />

Oktober <strong>2020</strong>, Graz<br />

Windhager R: Online Vortrag, „Current status of the trial (incl.<br />

the 2nd IDSMB report) and management under COVID-related<br />

safety measures”, 26.–27. November <strong>2020</strong> OSTEOproSPI-<br />

NE, Virtual Progress Meeting.<br />

Poster<br />

Hayer S: Distinct galectin profile in inflammatory-mediated<br />

cartilage damage. Poster presentation at the OARSI <strong>2020</strong>, Vienna,<br />

Austria<br />

Karner M, Stihsen C, Grohs J. Die Progressionsgeschwindigkeit<br />

der idiopathischen Adoleszentenskoliose und die<br />

Möglichkeit der Adaptierung des Untersuchungsintervalls.<br />

Jatros. Orthopädie & Traumatologie Rheumatologie 5 /<strong>2020</strong><br />

Moftakhar T: Inzidenz und Verletzungsmuster von Elektro-Scooter-assoziierten<br />

Verletzungen nach Einführung<br />

eines städtischen Leihprogramms in Wien – eine retrospektive<br />

multizentrische Studie, 56. Jahrestagung der Österr.<br />

Ges. für Unfallchirurgie (ÖGU) und 1. Jahrestagung der<br />

Österr. Ges. für Orthopädie und Traumatologie (ÖGOuT), 01.–<br />

03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Nia A: Varos-Schaftsystem – eine Pilotstudie für den klinischen<br />

Einsatz in der Frühphase der Rehabilitation, OTWorld,<br />

27.10.<strong>2020</strong>, Deutschland<br />

Payr S: Epidemiologischer Überblick über Frakturen der Wirbelsäule<br />

bei Kindern und Jugendlichen – Daten eines Level<br />

1 Traumazentrums, 56. Jahrestagung der Österr. Ges. für<br />

Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österr. Ges.<br />

für Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Payr S: Thorakolumbale Wirbelkörperfrakturen: Eine Herausforderung<br />

beim älteren Patienten, 56. Jahrestagung der<br />

Österr. Ges. für Unfallchirurgie (ÖGU) und 1. Jahrestagung<br />

der Österr. Ges. für Orthopädie und Traumatologie (ÖGOuT),<br />

01.-03.10.<strong>2020</strong>, Salzburg, Österreich<br />

Payr S: Wirbelsäulenverletzungen beim kindlichen und jugendlichen<br />

Polytrauma, 56. Jahrestagung der Österr. Ges. für<br />

Unfallchirurgie (ÖGU) und 1. Jahrestagung der Österr. Ges.<br />

für Orthopädie und Traumatologie (ÖGOuT), 01.–03.10.<strong>2020</strong>,<br />

Salzburg, Österreich<br />

Rienmüller A: Function as objective assessment using the<br />

TUG-Test is a useful tool to evaluate outcome in lumbar spinal<br />

stenosis surgery. 28.05.<strong>2020</strong><br />

Rothbauer M: Organs-on-a-chip as alternative to animal models<br />

in orthopedic musculoskeletal disease research, Annual<br />

Conference EUROoCS <strong>2020</strong>, Uppsala, Sweden, 8–9 July <strong>2020</strong><br />

Staats K: Osseointegrative Effekte von intermittierender<br />

Parathormongabe bei initialer Instabilität von zementfreien<br />

Implantaten, Endoprothetikkongress <strong>2020</strong>, Berlin, Deutschland,<br />

13.–15.02.<strong>2020</strong><br />

Starlinger J: Post-intervention changes in the relative motion<br />

between the surrounding subsynovial connective tissue (SSCT)<br />

and tendon in the carpal tunnel, Orthopedic Research Society<br />

Phoenix, Arizona, 08.-11.02.<strong>2020</strong>, Vereinigte Staaten (USA)<br />

Steinecker-Frohnwieser B: Activation of the mechanosensitive<br />

ion channel Piezo1/2 by Yoda1 modulates cellular functions<br />

of human OA chondrocytes. Poster presentation at the<br />

OARSI <strong>2020</strong>, Vienna, Austria<br />

Toegel S: Distinct galectin profile in inflammation-mediated<br />

cartilage damage. Poster presentation at the European Workshop<br />

for Rheumatology Research <strong>2020</strong>, Leuven, Belgium,<br />

13.–15.2.<strong>2020</strong><br />

Toegel S: Galectin-4 triggers disease markers in osteoarthritic<br />

chondrocytes via NF-kB. Poster presentation at the OARSI<br />

<strong>2020</strong>, Vienna, Austria<br />

Toegel S: Glycophenotyping of osteoarthritic fibroblast-like<br />

synoviocytes. Poster presentation at the OARSI <strong>2020</strong>, Vienna,<br />

Austria<br />

Schinhan M: Biological regeneration in a compartmentalized<br />

early stage of osteoarthritis: 12-month results of a randomized<br />

trial in sheep. Poster presentation at the OARSI <strong>2020</strong>,<br />

Vienna, Austria<br />

Fischer A: The novel H2S-releasing compound DP* reduces<br />

inflammation in osteoarthritic chondrocytes and fibroblast-like<br />

synoviocytes. Poster presentation at the OARSI<br />

<strong>2020</strong>, Vienna, Austria<br />

Weihs V: Psychokardiologische Aspekte in der akuten Phase<br />

des Takotsubo-Syndroms (TTS): Eine Untersuchung von<br />

TTS-Patienten hinsichtlich somatischer und depressiver<br />

Störungen, Resilienz und Krankheitswahrnehmung, DGPPN<br />

Kongress <strong>2020</strong>, 26.11.–28.11.<strong>2020</strong>, ONLINE, Deutschland<br />

Willegger M: Arthroscopic accessibility of the metatarsal<br />

head comparing distraction and plantarflexion in a 2 portal<br />

technique for the first metatarsophalangeal (MTP 1) joint<br />

AOFAS Annual Meeting <strong>2020</strong> 9.–12. September – San Antonio,<br />

Texas, USA (online)<br />

Willegger M: Tibial Coverage Of The Talar Dome In Different<br />

Ankle Positions<br />

Virtual EFFORT Congress 28.–30.October <strong>2020</strong> – Selected for<br />

Best Poster Session<br />

Willegger M: Intraoperative Glove Perforation During Implantation<br />

Of Cephalomedullary Nails For Pertrochanteric Fracture<br />

Fixation, Virtual EFFORT Congress 28.–30. October <strong>2020</strong><br />

Gastärzte/Beobachter<br />

Name Land Dauer<br />

Jamal Al-Omari Jordanien 1.09.2019-<br />

Fellow 31.03.<strong>2020</strong><br />

01.04.<strong>2020</strong>-<br />

31.03.2021<br />

Dr. Chang-Bae Kong Süd-Korea 24.02.<strong>2020</strong>-<br />

Fellow 23.02.2021


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